Pediatric Pelvic Floor Physical Therapy: Importance, Treatment, and Progression

By Dr. Zarina Vitebsky, DPT, MSPT, PRPC, TPS, LPF, DN on 10/20/2023

Overview

Definition of pediatric pelvic floor physical therapy

Pediatric pelvic floor physical therapy is a specialized form of physical therapy that focuses on the pelvic floor muscles in children. These muscles play a crucial role in bladder and bowel control. This type of therapy involves exercises, manual techniques, and education to help children improve their pelvic floor function and alleviate any related symptoms.

Importance of pelvic floor health in children

Pelvic floor health is important for children as it can affect their overall physical and emotional well-being. A strong and properly functioning pelvic floor can help with bladder and bowel control, and prevent urinary and fecal incontinence. It can also help with posture, balance, and core stability. On the other hand, pelvic floor dysfunction in children can lead to a range of issues such as bedwetting, constipation, and pelvic pain.

Common conditions treated with pediatric pelvic floor physical therapy

There are various conditions that can benefit from pediatric pelvic floor physical therapy, including bedwetting, constipation, pelvic pain, and pelvic floor muscle dysfunction. Bedwetting, also known as nocturnal enuresis, is a common issue in children that can be caused by weak pelvic floor muscles. Constipation, which can also be linked to pelvic floor dysfunction, can cause discomfort and difficulty with bowel movements. Pelvic pain, including pain during urination or bowel movements, can also be a result of pelvic floor muscle dysfunction. Pediatric pelvic floor physical therapy can help address these issues and improve overall pelvic floor function.

Benefits of early intervention

Early intervention with pediatric pelvic floor physical therapy can have numerous benefits for children. It can help prevent or improve symptoms of pelvic floor dysfunction, such as bedwetting, constipation, and pelvic pain. It can also promote proper bladder and bowel control, which can have a positive impact on a child's self-esteem and confidence. Additionally, starting pelvic floor physical therapy early can help children develop good habits and techniques for maintaining a healthy pelvic floor as they grow and develop.

Anatomy and Function of the Pelvic Floor

Description of the Pelvic Floor Muscles

The pelvic floor is a group of muscles that form a sling-like structure at the bottom of the pelvis. These muscles include the pubococcygeus, iliococcygeus, and puborectalis muscles. They are responsible for supporting the pelvic organs, including the bladder, uterus, and rectum.

Role of the Pelvic Floor in Bowel and Bladder Control

The pelvic floor muscles play a crucial role in maintaining bowel and bladder control. They work together with the urinary and anal sphincters to keep the urethra and anus closed, preventing leakage of urine and feces. These muscles also relax to allow for urination and defecation.

How the Pelvic Floor Changes During Childhood Development

The pelvic floor undergoes significant changes during childhood development. In infants and young children, the pelvic floor muscles are not fully developed, which can lead to issues with bowel and bladder control. As children grow and develop, the pelvic floor muscles become stronger and more coordinated, allowing for better control of the bladder and bowel.

Potential Issues with the Pelvic Floor in Children

There are several potential issues that can arise with the pelvic floor in children. These include urinary incontinence, constipation, and pelvic floor dysfunction. These issues can be caused by a variety of factors, such as weak pelvic floor muscles, nerve damage, or structural abnormalities. Pediatric pelvic floor physical therapy can help address these issues and improve overall pelvic floor function.

Signs and Symptoms of Pelvic Floor Dysfunction in Children

Urinary Symptoms

Pelvic floor dysfunction in children can manifest in various urinary symptoms, including:

• Incontinence - the inability to control urine flow

• Frequent urination - needing to urinate more often than usual

• Painful urination - experiencing discomfort or pain while urinating

Bowel Symptoms

Children with pelvic floor dysfunction may also experience bowel symptoms, such as:

• Constipation - difficulty passing stool or infrequent bowel movements

• Accidental bowel leakage - involuntary passage of stool

• Painful bowel movements - experiencing discomfort or pain while passing stool

Other Symptoms

In addition to urinary and bowel symptoms, pediatric pelvic floor dysfunction can also present with other symptoms, including:

• Pelvic pain - discomfort or pain in the pelvic region

• Postural issues - problems with posture or alignment of the pelvis

Evaluation and Assessment

Interview with the child and caregiver

The first step in pediatric pelvic floor physical therapy is to conduct an interview with the child and their caregiver. This allows the therapist to gather important information about the child's medical history, symptoms, and any previous treatments. It also provides an opportunity to establish rapport and address any concerns or questions the child or caregiver may have.

Physical examination

After the interview, a physical examination is conducted to assess the child's pelvic floor function. This typically includes observation of posture and movement patterns, assessment of muscle strength and flexibility, and a pelvic floor muscle assessment. The therapist will also check for any signs of pain or discomfort in the pelvic region.

Treatment Techniques

Education and Behavioral Modifications

Pediatric pelvic floor physical therapy often begins with education and behavioral modifications. This involves teaching children and their parents about healthy bladder and bowel habits, such as going to the bathroom regularly and fully emptying the bladder. Diet and fluid intake may also be addressed, as certain foods and drinks can irritate the bladder and contribute to urinary symptoms. Additionally, posture and body mechanics may be addressed to ensure proper alignment and muscle function in the pelvic floor.

Pelvic Floor Muscle Exercises

Kegel exercises, also known as pelvic floor muscle exercises, are a common treatment technique used in pediatric pelvic floor physical therapy. These exercises involve contracting and relaxing the muscles of the pelvic floor to improve strength and control. Biofeedback may also be used to help children learn how to properly engage and relax their pelvic floor muscles. In some cases, electrical stimulation may be used to help strengthen weak pelvic floor muscles.

Manual Therapy Techniques

In addition to exercises, manual therapy techniques may be used in pediatric pelvic floor physical therapy. This may include soft tissue mobilization, which involves using hands-on techniques to release tension and improve muscle function in the pelvic floor. Joint mobilization may also be used to address any restrictions or imbalances in the joints of the pelvis. Myofascial release, a type of massage that targets the connective tissue, may also be used to help alleviate pain and tension in the pelvic floor muscles.

Relaxation Techniques

Relaxation techniques can be helpful in reducing tension and improving overall pelvic floor function. Breathing exercises, such as diaphragmatic breathing, can help children learn how to relax their pelvic floor muscles. Visualization techniques, where children imagine their pelvic floor muscles relaxing and releasing tension, may also be used. Mindfulness techniques, such as body scans, can help children become more aware of their pelvic floor and learn how to relax it.

Home Exercise Program

To help children continue their progress outside of therapy sessions, a home exercise program may be prescribed. This may include a combination of the techniques mentioned above, as well as other exercises and activities tailored to the child's specific needs. Consistency with a home exercise program can greatly improve the effectiveness of pediatric pelvic floor physical therapy.

Progression and Follow-Up

Monitoring progress and adjusting treatment plan

As with any type of physical therapy, it is important to regularly monitor the progress of a child undergoing pediatric pelvic floor physical therapy. This can be done through various methods such as tracking symptoms, measuring muscle strength and flexibility, and assessing functional abilities. Based on the child's progress, the therapist may need to adjust the treatment plan to ensure optimal results.

Frequency and duration of treatment sessions

The frequency and duration of treatment sessions will vary depending on the individual needs of the child. In general, it is recommended to have at least one session per week for a minimum of 6-8 weeks. However, this may be adjusted based on the child's progress and response to treatment. It is important to attend all scheduled sessions and follow the recommended treatment plan for the best results.

Communication with the child and caregiver

Effective communication between the therapist, child, and caregiver is crucial for the success of pediatric pelvic floor physical therapy. The therapist should explain the treatment plan and goals to both the child and caregiver, and regularly check in with them to ensure understanding and address any concerns. The child and caregiver should also feel comfortable communicating any changes or improvements in symptoms to the therapist.

Referral to other specialists if needed

In some cases, a child may require additional support from other specialists in conjunction with pelvic floor physical therapy. This could include referrals to a pediatric urologist, gastroenterologist, or psychologist. The therapist will work closely with these specialists to ensure a comprehensive treatment plan for the child's specific needs.

Importance of ongoing maintenance and prevention strategies

Pediatric pelvic floor physical therapy is not a one-time fix, but rather an ongoing process. It is important for the child and caregiver to understand the importance of continuing with maintenance exercises and implementing prevention strategies to prevent future issues. The therapist should provide resources and guidance for these strategies to ensure long-term success.

If your child is experiencing pelvic floor dysfunctions, please reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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