Many children suffer from bladder/bowel voiding dysfunction. In fact, 20% of all pediatric visits are for incontinence problems. The good news is that non-invasive physical therapy techniques are highly effective for these disorders.
The umbrella term for difficulty with bladder/bowel control in children is “dysfunctional voiding.” Below is a list of different diagnoses that fall under dysfunctional voiding:
- Nighttime bedwetting (nocturnal enuresis)
- Daytime wetting
- Stress incontinence
- Overactive bladder
- Urinary frequency/urgency
- Urinary retention
- Frequent Urinary Tract Infections
- Vesicoureteral reflux
- Bowel incontinence and/or inability to empty bowel
- Fecal Urgency/Frequency
Bladder Voiding Dysfunction
Accomplishing brain and nervous system control over the bladder is not always fully realized by the time a child is toilet trained. Often, even after toilet training a child’s bladder will continue to act in the hyperactive/hypersensitive way of the automatic bladder of infancy. Couple this with the fact that toilet training takes place at a time when children are developing interests. In order not to interrupt the good time they’re having playing with friends or toys they may begin to hold their urine as long as possible.
This “holding” pattern results in contraction of the pelvic floor muscles and external urinary sphincter, which ultimately can lead to dysfunction, such as a chronic abnormal pattern of urinary voiding. For example, some kids will experience difficulty sensing bladder fullness, which will lead to daytime leaking or nighttime bedwetting. Others will experience urinary urgency and frequency. And still others will face frequent bladder infections.
As with bladder voiding dysfunction, bowel-voiding dysfunction is also a common problem for kids. The main issue surrounding bowel-voiding dysfunction is constipation.
Constipation is the infrequent and difficult passage of stool. As with adults, the frequency of bowel movements varies from child to child. That said, we encourage patients to try to have at least one bowel movement per day with management of physical activity and diet. Anything less than three per week is considered constipation.
Several different things can cause constipation, including avoidance of bowel movements because of pain caused by cracked skin known as “fissures,” diet, illness, travel, or generally poor bowel habits. For instance, as with urinary voiding, children can ignore the urge to have a bowel movement because they don’t want to interrupt what they’re doing. The child will “hold it in” by forcefully tightening the external sphincter and suppressing the urge to have a bowel movement.
Typically, if a child has bladder-voiding dysfunction, he or she will also have constipation, as the two tend to go hand and hand. In addition, it’s important to note that research shows that many adults who suffer from constipation also suffered from it as children.
How PT Can Help
When it comes to voiding dysfunction, pelvic floor PT helps in a myriad of ways.
The pelvic floor PT will treat the child’s poor pelvic floor muscle control with biofeedback. The patient will be connected to the biofeedback monitor via two externally placed stickers. Then the PT will ask the child to “contract,” “relax,” and “bulge” their pelvic floor using the biofeedback screen results for feedback. This process will help the child regain control of his or her pelvic floor.
And when it comes to constipation, biofeedback can also help by teaching the child how to push and lengthen the pelvic floor because often they simply aren’t doing it correctly.
In addition, the PT will work with them on how to use their breath to assist with pelvic floor motor control. Oftentimes, bubbles are used for this exercise.
Also, the PT will educate the child about the bladder and bowel systems so that they come to understand that their voiding problems are not “just something that happens,” but that there’s a reason behind it. This further gives the child a sense of ownership and control over the issue. Games, books, and pictures are used to teach the child about the anatomy. PT also helps pediatric patients with whatever behavioral issues are involved in their voiding dysfunction.
Typically, it takes the PT about two visits to get a full picture of what is behind the patient’s voiding dysfunction. More often than not there are a combination of muscle control and behavioral issues to treat.
The initial evaluation is an hour-long appointment, and regular appointments range from thirty minutes to one hour. A guardian will always be in the room during each appointment and a child is generally seen from six to eight visits.