What Is Pediatric Pelvic Floor Therapy?

Have you ever been told that your child will just outgrow their toileting issues OR to just give them Miralax and it will get better? You are not alone! We hear from exasperated parents all the time about healthcare providers who said “just wait and see”….

While some kids will eventually outgrow their problems, most will not. That is where pediatric pelvic floor therapy comes in…

What Is Pediatric Pelvic Floor Therapy?

Pediatric pelvic floor therapy is specialized treatment provided by licensed occupational and physical therapists. It is a highly individualized service, based on your child’s symptoms, needs, and goals. We often address incontinence, constipation, bedwetting, toilet refusal, pelvic pain, and more. The development of pelvic floor function and ultimately bowel/bladder control goes beyond just your child’s pelvic floor muscles, as it is deeply interconnected with their mental health, routines, nervous system, and so much more.

But wait….what even IS the pelvic floor? You can read more about it here! While that blog post focuses on the female anatomy (specifically focused on pregnancy/postpartum), the basic concepts still apply! We all have pelvic floors, and our children are no exception. The pelvic floor consists of muscles and connective tissue that stabilize the pelvic bones and support the pelvic organs (bladder, uterus, rectum). Think of these muscles like a hammock or trampoline. They need to be able to fully contract and fully relax to provide optimal support and allow for bladder and bowel function. Learning to control the muscles to coordinate bowel and bladder function in children takes a lot of work! When dysfunction occurs, we see things like bedwetting, incontinence, constipation, and toilet refusal happen. While sometimes children can outgrow these problems, most of the time therapy is needed!

As occupational therapists, with specific training in pediatric bowel and bladder dysfunction and pelvic floor therapy, we take a holistic approach when working with children. Our ultimate goal is to help your child participate in meaningful daily activities without worrying about having accidents, feeling constipated, or worrying about where to go.

What Do Pediatric Pelvic Floor Therapists Treat?

• Bedwetting
  Bedwetting, or nocturnal enuresis, refers to involuntary urination during sleep. This common issue in children can be linked to a variety of factors, including underdeveloped bladder control, deep sleep patterns, or emotional stress.

• Constipation
  Constipation occurs when a child has infrequent, painful, or difficult bowel movements. It can result in discomfort, anxiety about using the toilet, and sometimes even leakage due to a full bowel pressing against the bladder.

• Diastasis Recti (Tummy Separation)
  Diastasis recti is the separation of the abdominal muscles, often occurring during pregnancy or as a result of certain physical conditions. In children, it can contribute to posture issues, difficulty engaging core muscles, and sometimes pelvic floor dysfunction.

• Difficulty Emptying the Bladder
  When a child has trouble fully emptying their bladder, it can lead to urinary retention, discomfort, and increased risk of urinary tract infections. This issue may be caused by muscle weakness or coordination problems within the pelvic floor.

• Difficulty with Potty Training
  Potty training difficulties can arise when a child struggles with the physical or emotional aspects of using the toilet. This might include challenges with bladder control, fear of the toilet, or sensory sensitivities that make the experience overwhelming.

• Dysuria (Pain with Urination)
  Dysuria refers to pain or discomfort during urination. This can be caused by infections, irritation, or pelvic floor dysfunction, and may lead to avoidance of urination, which can worsen the problem.

• Frequency / Urgency of Urination
  Frequent or urgent urination is when a child feels the need to urinate more often than usual or experiences an overwhelming sense of urgency. This could indicate an overactive bladder, anxiety, or bladder muscle dysfunction.

• Giggle & Stress Incontinence
  Involuntary leakage of urine during laughter, sneezing, or coughing is known as giggle incontinence. Stress incontinence happens when physical pressure on the bladder leads to leaks, often due to weakened pelvic floor muscles.

• Overactive Bladder
  An overactive bladder causes a frequent need to urinate, often with little warning. It can be caused by a variety of factors, including nerve signals that trigger urination too often, and may lead to accidents or difficulty holding urine.

• Sensory Processing/Interoception Challenges
  Sensory processing and interoception challenges involve difficulty recognizing or responding to bodily sensations, such as the feeling of needing to urinate or defecate. Children with these challenges may struggle with potty training or controlling their bladder and bowels.

• Toilet Refusal
  Toilet refusal is when a child actively avoids using the bathroom, often due to anxiety, fear of the toilet, or a traumatic experience related to potty training. This can interfere with normal bowel and bladder function.

• Underactive Bladder
  An underactive bladder refers to a bladder that doesn't fully contract to empty itself during urination, leading to urinary retention. This condition can result in discomfort and frequent urinary tract infections.

• Urinary Leakage
  Urinary leakage occurs when a child experiences involuntary loss of urine, which can happen during physical activity, laughing, or even while sleeping. It is often related to weak pelvic floor muscles or poor bladder control.

• And More!
  Many other challenges related to pelvic floor dysfunction can affect children, from painful bowel movements to difficulty sitting on the toilet. Each child’s needs are unique, and therapy can help address a wide range of issues to support your child’s health and well-being.

What Does Pediatric Pelvic Floor Treatment Look Like?

At our clinic, we take a trauma-informed, play-based approach to pediatric pelvic floor therapy. Every treatment is tailored to your child's specific needs, ensuring that they receive care that’s both effective and engaging. Using play and hands-on activities, we work with your child to address the following key areas of development:

• Strength & Coordination
  Strength and coordination are essential for the proper functioning of the pelvic floor and overall physical health. We use fun, interactive activities to help your child build muscle strength and improve coordination in a way that feels like play rather than a workout.

• Balance
  Good balance supports better control of bodily functions, including bladder and bowel control. We use exercises that help your child develop stability and improve their sense of body awareness, which can contribute to more effective control of the pelvic floor.

• Posture & Alignment
  Proper posture and body alignment are crucial for maintaining pelvic floor health. We teach children how to sit, stand, and move with the right alignment, which can prevent pelvic floor strain and promote healthy function.

• Sensory Processing
  Sensory processing involves how the brain responds to stimuli from the body and environment. For children, challenges with sensory processing can impact potty training and bladder control. We address these challenges through targeted activities to improve your child’s awareness of bodily sensations.

• Primitive Reflex Testing & Integration
  Primitive reflexes are automatic movements that should integrate into more voluntary movements as children grow. If these reflexes persist, they can interfere with potty training and pelvic function. We assess and help integrate these reflexes to support your child’s development.

• Breathing & Airway Function
  Effective breathing is key to pelvic floor function. We help children develop proper breathing techniques to support relaxation of the pelvic floor muscles, improving both bladder and bowel control.

• Nervous System Regulation
  The nervous system plays a vital role in how the body manages bladder and bowel control. Through specific activities and techniques, we help regulate the nervous system to support the development of appropriate bathroom habits.

• Healthy Habits & Routines
  Establishing healthy daily habits and routines can make a big difference in potty training and bowel health. We guide families on creating routines that encourage regular toileting and promote pelvic health, ensuring lasting results.

• Toileting Mechanics
  Teaching proper toileting mechanics—like positioning and relaxation—can improve your child’s ability to successfully use the toilet. We work with your child to develop these essential skills, making potty time easier and more effective.

• Pelvic Floor or “Potty Muscles” Relaxation & Strengthening
  The pelvic floor muscles need to both relax and contract effectively for proper bladder and bowel function. We focus on exercises that help your child strengthen and relax these muscles, making it easier for them to manage their bodily functions.

In addition to these core focus areas, we use various therapeutic techniques to enhance your child’s progress, including:

• Soft Tissue Mobilization & Abdominal Work
  These techniques are used to release tension and promote flexibility in the muscles and connective tissue, which can help improve pelvic floor function and overall comfort.

• Myofascial Release
  Myofascial release targets tightness in the muscles and fascia, which can help alleviate pain, improve mobility, and support proper pelvic function.

• Biofeedback
  Biofeedback provides real-time feedback to help children understand how their pelvic floor muscles are functioning. This allows them to make the necessary adjustments and gain better control.

• Individualized Home Programs
  We create tailored home programs to ensure that your child continues to make progress outside of therapy. These programs are designed to be easy to follow and can include exercises, habits, and tips that complement in-clinic care.

Unlike adult pelvic floor therapy, which may involve internal assessments or treatments, pediatric therapy takes a different approach. With your consent, we may perform an external examination of your child’s pelvic floor muscles to assess their function. Throughout this process, your therapist will thoroughly explain each step and answer any questions you may have to ensure your child feels safe and supported.

Pretty cool right? If you think your child could benefit from services, Click here to reach out! Help us change the narrative around “just wait and see…” and get the help your child deserves today!