Pediatric Pelvic Health: Common Concerns, and How Pediatric Pelvic Floor Physical Therapy Can Help
Pelvic health is a topic many parents may not think about until toileting becomes stressful. If your child is struggling with accidents, constipation, or difficulty recognizing when they need to go, there are often very real and very treatable reasons behind it. Below are some of the most common causes of toileting challenges, along with practical strategies you can start using at home.
If your child is experiencing these issues, they may benefit from physical therapy or occupational therapy. At Cheshire Fitness Zone Pediatric Therapy, we treat a range of pediatric concerns, including issues related to pelvic health.
In this blog, we will review common pediatric pelvic health concerns, why they happen, and how pediatric pelvic floor physical therapy can help.
This blog is written by pediatric physical therapists, Marissa Bowen, DPT and Anneliese Sensini, DPT.
What does “pelvic health” mean for kids?
Pelvic health includes how the bladder, bowel, and pelvic floor muscles work together. When something is not working smoothly, kids may struggle with accidents, constipation, frequent urination, or difficulty sensing when they need to go.
Many kids continue to have accidents even after being toilet trained. This can happen for a variety of reasons, including constipation, holding habits, sensory concerns, or difficulty recognizing body signals.
If your child is experiencing any of these challenges, the first step is knowing this is common and there are many ways to help.
What should I do if my child is having trouble with toileting or is having accidents?
First, take a deep breath and know you’re not alone. Lots of kids have trouble with toileting and even have accidents after having been toilet trained. Let’s look at some common causes of incontinence and what to do about it.
Common Causes of Toileting Challenges
Toilet Training Difficulty
What is it?
Some kids take longer than others to toilet train initially. This can be especially true for kids with sensory concerns such as ADHD, autism, or even just sensitivity to itchy clothing or picky eaters. Be sure your child is getting plenty of fluids and a good amount of fiber from fruits, veggies, and whole grains.
Tips to Try at Home
Start with timed toileting. Take them to the bathroom on a regular schedule, whether or not they feel like they need to go. There is no pressure during these toilet visits. Just have them sit and try to go. If they don’t go, no problem. Praise the effort and try again next time. If they are successful, provide lots of positive reinforcement (stickers, cheering, whatever is motivating to your child).
Once your child can hold between trips to the toilet, you can work on them being able to feel it when they need to go. Talk about what you feel when you need to go to the bathroom. Ask them what they feel just before doing a toilet try and what they feel like right after.
Constipation
What is it?
Children should have bowel movements pretty much every day, and should have stools that are soft and easy for them to push out. Kids who have bowel movements less frequently, have hard stools, or difficulty pushing them out are constipated.
If your child is having difficulty with constipation, be sure they’re getting adequate fiber and fluid to keep the stool soft and easier to pass. Children between the ages of 2-5 should usually drink 4-5 cups of liquid a day and get 7-10 grams of fiber.
Bowel and bladder concerns often overlap. Many kids who struggle with bladder accidents also have constipation. Supporting bowel habits is often a key part of improving bladder control.
Tips to Try at Home
Have your child sit on the potty for a few minutes after eating to try for a poo. This is when they’re most likely to have success. You can read a story to help them relax, or have them do a little light blowing on a pinwheel to help with pushing.
Be sure their feet are well supported, not dangling. If they’re using a big toilet, have them use a foot stool and a toilet ring to make the opening smaller. The goal is for them to be very stable as they’re sitting.
Blowing games are a good way to strengthen the abdominal muscles used in pooping. You can encourage your child to blow on pinwheels, blow through straws, blow balled up tissues, blow bubbles in the bath/pool, blow whistles, etc.
Urine Accidents
While it’s normal for a child to have an occasional urine accident or dribble, it’s not something that should be happening regularly, once they’ve been potty trained. Urine accidents can have a variety of causes, so it’s important to look at your child’s habits to try to get a feel for what’s happening:
Holding Too Long
What is it?
Children typically urinate between 5-8 times a day. Many kids get really involved in playing (or watching tv/tablet) and don’t want to stop to go use the toilet. You may recognize the signs of this. Doing the “pee-pee dance”, crossing their legs, or even sitting on their heel.
Helpful Tip
Some children respond well to “timed toileting”, or going on a timed schedule, often every 2 hours. This helps develop a new habit of using the bathroom regularly, rather than holding as long as possible.
Some kids like using a “potty watch” to help them remember to go on schedule without being told to do so by an adult. This can help foster independence, especially in older kids, who may need help remembering the schedule at school/daycare or when away from their parents. After they get used to the new schedule, you can back off on the reminders and see if they can keep up the schedule on their own.
Lack of Urge Sensation
What is it?
Some kids have difficulty recognizing the need to use the toilet. This sense of the internal status of our bodies is called “interoception”, and it takes longer to develop in some kids than others.
These kids tend to do well with timed toileting, but also lots of discussion about what their bodies are telling them in a variety of situations.
Helpful Tip
Talk to them about how their bodies tell them they’re hungry or thirsty, or feel hot/cold. What do they do about it when they get these sensations? If it’s hot, do they sweat or take off a layer of clothes?
Talk openly about the sensations you have in your own body when you need to use the bathroom. You can have them press gently on their bellies near the bladder when it’s time to use the toilet. Talk about what they feel. Do it again after using the bathroom and see if it feels different.
Frequent Urination
Kids who urinate more than 8 times a day often fall into one of two categories. Most have underlying constipation, but some have fears about having an accident and go pre-emptively to try to avoid one.
What is it?
Kids are small and if they are constipated, the retained stool can take up more than its fair share of space in the abdomen and the bladder doesn’t have the usual amount of space to expand.
Signs of this are kids who go from “zero to 60” very quickly with their need to use the bathroom. They may or may not leak on the way to the toilet.
When managing this, it is essential to address the underlying constipation first. Be sure they’re getting lots of water, even if it seems counter-intuitive. This will help clear the constipation by making the stool softer.
Some kids are clever and figure out they don’t have to go to the bathroom as often if they don’t drink as much. While it may help cut down on the number of times they go to the bathroom, it only feeds into the constipation and can prolong the issue, or even cause more problems with increasing constipation.
Be sure they are getting adequate fiber, as well, to help with constipation.
Kids who have had an embarrassing accident in the past can sometimes be worried about having that happen to them again. They can become a bit fixated on going to the toilet before they even need to, to avoid another accident.
This can often present as a kid who has to pee all the time at school/out in public, but not so much at home. They may also avoid drinking fluids, leading to possible constipation.
Additionally, always going to the bathroom before you need to can actually cause the bladder to shrink a bit and really be able to hold less urine, only making the problem worse.
Helpful Tip
A good start here is to have them practice holding in urine at home, when they’re in a safe place. They can practice waiting to urinate until they feel the urge to do so, and then see if they can hold it another 5 minutes before going. Be sure to reassure them that it’s ok if they have a leak during this practice. That’s why it’s called practice.
As they get better at it, have them try holding a bit in familiar places out of the home, where they know they can get to a toilet easily, if needed. As they get better at it, they can expand the situations they hold through until the frequent urination is a distant memory.
Stool Accidents
More often than not, stool accidents happen because of built up constipation. When a child is constipated, they often learn to hold bowel movements out of fear of it hurting when they go to the bathroom. This becomes a problem when they keep holding it.
What is it?
Stool backs up in the rectum (where stool is held before being pushed out) and basically causes a clog. Since they’re still eating, there’s a constant arrival of new stool. When it meets up with the clog, the fresh stool is often liquidy enough to ooze through the clog, and leaks out as wet farts or even as a thick, pasty mess.
One of the most frustrating parts of this for parents is that the kids can’t control the leakage and don’t usually even feel it happening.
Another issue that arises when the rectum gets overstretched is that it stops signaling the brain of the need to poop, so kids will often not even feel that they need to go, even though they’re completely full of stool.
Once a child becomes this constipated, it usually is best to have some professional help to clear it. It’s important to make an appointment with the pediatrician, who can guide you along the steps of getting cleaned out and make any referrals to a GI doctor or pelvic health physical therapist to help you along the way.
Helpful Tip
The most important (and most difficult) thing is to remember that the child really doesn’t know they need to use the toilet and really doesn’t feel the stool leaking out of them.
They can be expected to help clean up, the same as they would any mess they make, but it’s vital not to punish them or make them feel bad about it, because that often causes them to hide dirty underwear, making it harder to know what’s going on.
One of the most frustrating parts of this for parents is that the kids can’t control the leakage and don’t usually even feel it happening.
Another issue that arises when the rectum gets overstretched is that it stops signaling the brain of the need to poop, so kids will often not even feel that they need to go, even though they’re completely full of stool.
When to Consider Pelvic Floor Physical Therapy
If your child’s symptoms are persistent, if accidents are happening regularly, or if you feel stuck even after trying routines at home, pelvic floor physical therapy can help identify what is driving the issue.
How does pelvic floor physical therapy work for kids?
Pediatric pelvic floor physical therapists are specially trained physical therapists who will work with you to help figure out what is causing your child to have difficulty with toileting.
We work with you and your child to understand the mechanisms behind the issue and find the right plan to get them back on track. We also work with you and your doctor to be sure any medical concerns are being addressed. We will have your child do exercises to stretch and strengthen the muscles that are involved, often by playing games or doing fun activities, so they don’t even know they’re working.
Though the idea of pelvic floor physical therapy can be scary for children and even parents, rest assured that your child will never be asked to do anything that they or you are uncomfortable with. We spend time getting to know each child and move at a pace that works for everyone.
We will also work with you to be sure your child’s diet, fluid, and toileting habits are supporting success.
How does pediatric pelvic health occupational therapy work for kids?
Pediatric pelvic floor occupational therapists also play a big role in treating kids with toileting concerns. Occupational therapy specializes in the sensory needs of children, and kids with bowel and bladder problems often have a sensory component.
Incontinence is much more prevalent in kids with ADHD, for example, and picky eaters are often constipated.
I am interested in pelvic floor therapy for my child, what are next steps?
You are not alone. Toileting concerns can feel stressful and isolating, but they are very common. With the right support, many kids make meaningful progress.
Each child will have a thorough evaluation after your child receives a referral from your pediatrician, and the treatments will be designed specifically for them. What works great for one child may not work for another, so we work together to fine-tune the activities to each individual child.
Managing all the different factors can be tricky, but we are here to help guide you through the process, breaking it down into manageable and concrete steps, so you know exactly what to be doing to help your child.
We will work hard to make sure you, the parent/caregiver, understand what is going on, so that you can be a part of the treatment and have the confidence to know you can manage any issues in the future.
Cheshire Fitness Zone is Here to Help
In many cases, kids do not grow out of toileting issues simply by waiting. The good news is that pelvic health concerns are often very treatable when you identify the root cause and build consistent routines. Pediatric pelvic floor physical therapy can help you understand what is going on, support your child in a way that feels safe and age-appropriate, and create a plan that works for your family.
At Cheshire Fitness Zone Pediatric Therapy, our team includes trained and experienced physical and occupational therapists who support pediatric pelvic health and toileting concerns. If you have questions about your child qualifying for pelvic health services, please don’t hesitate to reach out to our office.
