What is pediatric pelvic floor physical therapy?

 

Many children experience bedwetting, urinary/fecal leakage, or constipation. Pelvic floor physical therapists and occupational therapists can undergo additional training to help children and their families manage these issues while they are also receiving care from their physicians. In some cases, when children use strategies to hold in urine or stool, they may end up using their pelvic floor muscles incorrectly. This can result in long-term bowel or bladder problems, as well as psychological distress such as bullying at school and strain on the entire family.

 

We also treat more complicated medical conditions, such as post-gastrointestinal or post-bowel and bladder malformation surgeries and other bowel or bladder problems. 

 

How is pediatric pelvic floor physical therapy different from regular pediatric physical therapy?

 

Pediatric pelvic floor therapy is different from regular physical therapy for kids in that we focus on the pelvic floor and other holistic factors that may contribute to bowel and/or bladder problems. Pelvic floor physical therapy requires a team effort between the therapist, parents, and the child's doctor, and we may recommend lifestyle changes for the whole family. 

 

Many times, during regular pediatric physical therapy, the parents stay in the waiting room while the child is being treated in the therapy room. This is often a good thing since the kids tend to focus better when mom or dad is not in the room. Unless otherwise recommended, during pelvic floor therapy at our clinic, the parents are in the room and fully participate in the therapy session and plan of care. 

 

We understand that many parents and children coming for pelvic physical therapy may already have been through a certain amount of trauma due to complicated medical diagnoses, and we need to structure our sessions so they can be most beneficial to the child. 

 

​Nobody understands your child better than you, and we incorporate parent instincts about what may be the best way to teach your child as we proceed through the therapy plan of care. As a pediatric pelvic health therapist, we educate and work with the parents as much as we do with the child.

 

Depending on the child's age, we may prefer to have some visits via telehealth or Zoom with the parent/s present only, where we do not have to discuss "boring" bowel and bladder strategies in front of the child. This will also allow the parents to ask questions freely. 

 

How is pediatric pelvic floor physical therapy the same as regular pediatric physical therapy?

 

Like regular physical therapy sessions, we use games, gross motor equipment, and a fun approach to perform our therapy. Some of our visits may look just like a regular pediatric visit when we focus on balance, strength, and posture.  

 

How do you structure your sessions at Trailhead Pelvic & Visceral Physical Therapy? Understanding what to expect may help us prepare for pediatric pelvic floor therapy.

 

The following may give you, as a parent, an idea of what therapy may look like, but please understand that their age, diagnosis, personal factors, parent choice, or therapist recommendation will play a role in how we proceed with our plan of care. 

 

We structure our visits to meet your child where they are and help them feel comfortable and involved in decision-making. We feel that it is crucial that your child bond with our pelvic floor physical therapist and leave the first visit thinking that peeing and pooping is the coolest thing ever.

Before we can give them pelvic floor exercises, we need to ensure that they know what we are talking about (anatomy), can feel their body's signals (interoception), and understand why we are teaching them about their problem. 

 

We typically start teaching anatomy and interoception using puzzles, storybooks, anatomy models, and games. Next, we may proceed to a bowel and bladder diary to see if diet plays a role in their problem and add an orthopedic evaluation to see if general weakness and muscle posture contribute to their problem. We will also teach them bowel and bladder strategies like posture on the toilet and how to push when having a bowel movement. 

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For some kids, just the above is enough to make significant progress. We can then proceed to the pelvic floor. We have many options available and will discuss with the parent what may be the most appropriate for your child. Pelvic floor exercises could include using surface EMG to read whether they are using their muscles correctly or not. With surface EMG, they do not feel anything through the electrodes (no electrical feeling) and can see on a computer screen how to adjust their muscle contraction. 

 

We hope this Q&A has been helpful. Please feel free to ask questions at any time during this process. 

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I am looking forward to working with your child.

Sunel

(Pediatric pelvic floor therapist)