“How long have you been dealing with the severe constipation and the skid marks in your underwear?”
The boy before me looked up with a mixture of exasperation and defeat.
“My entire life,” he said.
He was 18 years old.
This young man had been coming to the children’s hospital throughout his life for procedures that provided temporary relief. But soon, the cycle would start again, and he would be back to stained underwear, stomach pain, and the sting of shame. Luckily, thanks to pediatric pelvic floor physical therapy, conditions like his do not have to become lifelong problems.
You may have heard of pelvic floor physical therapy for adults— often for moms. However, kids have pelvic floors, too! Pediatric pelvic floor PT is an effective treatment for many childhood issues, including bedwetting, constipation, encopresis, and incontinence. Some signs that your child may benefit from pelvic floor PT include
- Bedwetting beyond the age of 7
- Daytime incontinence beyond the age of 4 (delayed potty training)
- Delaying toileting as long as possible, often with “avoidance maneuvers” such as crossing legs and standing on tiptoes
- Bowel movements less than 3 times/week
- Large bowel movements that clog the toilet
- Showing signs of fear, anxiety, or even pain with toileting
- Streaks of stool in underwear despite proper hygiene
- Complaints of pelvic pain
Pelvic floor PT entails exercises that address the child’s specific condition and education for the child and family about pelvic health. Sometimes, they need to make lifestyle changes, such as adjusting fluid or fiber intake. Pediatric pelvic floor therapists use games, rewards, and plenty of imagination to make therapy more enjoyable for kids. For example, they might use sticker charts to incentivize a child to follow through with an exercise plan. Some therapists also use technology called biofeedback. Biofeedback involves sensors, placed on a child’s skin, that track muscle activity. These sensors are connected to a computer, so the child can play video games by squeezing and relaxing their pelvic floor muscles. Pretty cool! Kids can start pelvic floor PT as soon as they are old enough to understand basic instructions and simple information, typically around 4 years old.
Unlike adult pelvic floor PT, pediatric therapy never involves internal pelvic floor muscle exams or treatment. A therapist can gather plenty of information with a thorough report from the child’s parent and an external physical exam.
Figuring out whether or not your child needs pelvic floor therapy can be difficult. Many children do not talk about their symptoms, often because they don’t know they have a problem. Others may be afraid to talk to adults about what’s going on for fear of punishment or shame. As a parent, it is important to remember that your child might not have full control over their pelvic floor, especially if they are less than 5 years old. If you suspect your child is struggling with a pelvic health problem, try to talk to them about it in a caring and gentle way. Remind them that it isn’t their fault, and you aren’t angry. Finally, talk to your pediatrician about your concerns rather than assuming your child will “grow out of it.”
I never found out what happened to the young man I met at the hospital. I gave him as many resources as possible and referred him to pelvic floor therapy clinics. Then, he was discharged. However, I’ve learned throughout my career that his experience is not unique. I’ve met several people whose childhood pelvic floor dysfunction followed them into adulthood. Like many of the moms I treat in my pelvic floor PT practice, these individuals believe their experience is “just the way it is.” This couldn’t be further from the truth. Pediatric pelvic floor PT, especially when started earlier rather than later, is effective, non-invasive, and less expensive than many other treatments. My hope is that by raising awareness about pediatric pelvic floor disorders and how PT can help, more children will get the support they need to overcome their conditions and go on to live happy, fulfilling adult lives.
Dr. Savannah Carlson, PT, DPT, RYT is the owner of Rhea Physical Therapy, LLC. Savannah provides personalized, in-home pelvic floor therapy to women and children in the St. Louis area, as well as virtual care for individuals in Illinois and greater Missouri. Her mission is to help every woman and child overcome pelvic floor dysfunction so they can reach their full potential at home, work, and play. She earned her doctorate in physical therapy at Washington University in St. Louis. Learn more about Rhea Physical Therapy at www.rheaphysicaltherapy.xyz or follow Savannah on Instagram @rhea.pt.stl