On October 6th 2021, over 75 countries will commemorate World Cerebral Palsy Day. Cerebral palsy (CP) is the most common neurodevelopmental disorder of childhood, affecting approximately 1 in 345 children. Although the impact of CP varies, it typically causes the muscles in the body to be too tight or too loose. Children with CP can experience difficulties with balance, movement, or fine motor tasks.
The pelvic floor muscles that help to control our bladder and bowel can be just as impacted by CP as the muscles in the arms and legs. If the pelvic floor muscles are too tight, too weak, or have difficulty working together, their ability to control bladder and bowel function can be impacted.
While not every pelvic floor therapist has experience working with children, Grace Physical Therapy is excited to offer services to children aged five and older. Our therapists are trained to address a variety of concerns seen in the pediatric population including constipation, daytime urinary/fecal leakage, and bed wetting.
Constipation
What is constipation?
In children, constipation is one of the most common underlying causes of urinary leakage. It is one of the most common things we treat. In children, signs of constipation can include:
- Having fewer than 3 bowel movements per week
- Having bowel movements that are hard, difficult to pass, or painful
- Abdominal dissension/bloating
- Decreased appetite
- Fowl body odor
- Fear of using the restroom or withholding bowel movements
Another common sign of constipation in children is bypass diarrhea, or the passage of liquid stool that may or may not be accompanied by a formed bowel moment. This stool is difficult to detect and children are often unaware of it until they notice it on their underwear. For many children, bypass diarrhea is one of the more bothersome symptoms of constipation and can lead to feelings of embarrassment.
What causes constipation in children?
In order for us to have a bowel movement, the pelvic floor muscles must be able to relax. If the pelvic floor muscles have a hard time relaxing, or if they tighten before we are able to have a complete bowel movement, we can become constipated. Just like adults, many other things can contribute to constipation in children. These include:
- Dietary habits Including inadequate liquid and fiber intake
- Certain medications (including antacids, antidepressants, and narcotic pain medications)
- Certain medical conditions (such as diabetes, hypothyroidism, and conditions of the central nervous system including Cerebral Palsy and Spina Bifida)
- Voluntary withholding of bowel movements secondary to fear, stress, or embarrassment
Daytime Urinary/Fecal Leakage
What other symptoms can accompany daytime leakage?
Daytime leakage, often called “accidents”, are extremely common, especially in young children. These “accidents” can vary in size and may occur in clusters. For many children, daytime leakage is accompanied by one or more of the following:
- Urgency of urination (a sudden strong urge to urinate that often comes without warning)
- Urinary frequency (urinating more often than every 2-4 hours or 8+ times per day)
- Infrequent urination (urinating three or fewer times per day)
- Incomplete urination or a feeling of immediately needing to re-empty the bladder
What causes daytime urinary or fecal leakage in children?
As previously mentioned, one of the most common causes of urinary or fecal leakage in children is constipation. As the colon and rectum expand to make room for more stool, greater pressure is placed on the bladder. This makes it harder for the bladder to expand and hold urine, leaving the person prone to leakage. Pelvic floor muscle tension can also contribute to urinary leakage by reducing the muscles ability to generate the strength needed to keep urine in the bladder. Additionally, difficulty coordinating the pelvic floor muscles can result in reduced strength and difficulty recognizing or responding to cues from the bladder. Daytime leakage can also be caused by:
- Bladder, kidney, or urinary tract infections
- Overactive bladder (urge incontinence)
- Voluntary withholding
- Anatomical variations in the urinary tract
Bed wetting
What causes bed wetting in children?
Bed wetting, also known as nocturnal enuresis, is extremely common. Although children are often dry through the night by age five, bed wetting until age seven usually isn’t a concern. When bed wetting persists, it can be a source of stress for children and their families. In addition to the ways in which the pelvic floor muscles contribute to daytime leakage, common causes of bed wetting in children include:
- A small bladder (resulting in less space to hold urine at night)
- Sleep apnea, mouth breathing, and other sleep disorders
- Inability to recognize a full bladder secondary to deep sleeping
- Constipation
For some children, these concerns resolve on their own. If they don’t, it can be beneficial to work with a pelvic floor therapist. A therapist trained to work with children can help them better understand how their body functions and the things that are contributing to their concerns. Pelvic floor therapists work with children and their families to establish a treatment plan that will help them reach their goals. Some of the common treatment strategies and tools used in the pediatric population include biofeedback, bladder and bowel retraining programs, and breath work.
Biofeedback
Biofeedback involves using external sensors that stick onto the skin. The sensors pick up the electrical activity of the pelvic floor muscles and turn it into a signal that we can see; you don’t feel anything when you do biofeedback. We can use that signal to help the pelvic floor muscles learn to contract and relax, make them stronger, or give them better endurance. We can even play games to help train the muscles!
Bladder and bowel retraining programs
Pelvic floor therapists can help children and their families establish healthy bladder and bowel routines that meet their needs. For some children, this means coming up with a “potty schedule” that helps them remember to go to the bathroom at regular intervals. For other children, this may involve establishing healthy routines to stimulate a bowel movement. And for children experiencing bed wetting, exploring the Dry Nights/Dry Mornings program can be beneficial.
Breath work
The diaphragm, the muscle that sits under the ribcage, plays a major role in moving our pelvic floor muscles. When we breathe in with our diaphragms, our pelvic floor muscles lengthen and relax. However, when we breathe, we tend to use other muscles instead. This causes our pelvic floor muscles to move and work less efficiently. Pelvic floor therapists can help children learn to use their diaphragms to breathe; this improves the mobility and function of the pelvic floor muscles.
If you are concerned about your child’s bladder or bowel habits, it is a good idea to talk to your pediatrician. They can send a referral to our office if they suspect the pelvic floor muscles are contributing to these concerns. A trained pelvic floor therapist will help determine if pelvic floor therapy is right for your child and the treatment strategies that will be the most effective at helping them achieve their goals.
We look forward to working with you!
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