Back to School Series: Pediatrics and the Pelvic Floor

Childhood Constipation and how Pelvic Floor Therapy Can Help

Does your kiddo have a hard time passing bowel movements?

If the answer is yes, you are not alone. According to (Mugie et al. (2011) up to about 30% of children experience constipation. In fact, kids admitted to the emergency room with abdominal pain are most often diagnosed with constipation (Caperell, Pitetti, & Cross, 2013).

Kids who don’t get treatment for their constipation may start falling into muscle holding patterns that persist into adulthood. This means that childhood constipation problems may lead to adult constipation and other pelvic floor issues.

What are the Symptoms of Constipation?

Typically, two or more symptoms of the following:  

• Fewer than 3 bowel movements per week 
• Bleeding or pain with bowel movements
• Straining to pass BM (holding breath, face turns read, can’t talk and push at the same time)
• Hard or lumpy stools
• Feeling like you didn’t fully evacuate
• Sensation of blockage at the level of the anus and rectum
• The need to use fingers or other manual maneuvers to have a bowel movement
• Abdominal pain
• Stools that plug the toilet
• Lack of appetite
• Urinary incontinence (leakage) or increased frequency
• Fecal leakage (liquid stool moves around the impacted stool)
• Acid Reflux

How does childhood constipation lead to pelvic floor issues?

Constant straining with bowel movements will cause the muscles of the pelvic floor to spasm or become weak. If your kiddo’s constipation triggers pelvic floor weakness or spasm, these muscle holding patterns can stay around as they get older, and for some, these issues persist into adulthood.

Read more on the basics of constipation on the Femina Blog.

I think my kid has constipation, what do I do now?

If you think your child may have constipation, let your pediatrician know or get a referral to a pediatric gastroenterologist. These doctors can help rule out other serious causes of constipation that may require medical attention.

If the doctors believe that the constipation is functional, meaning it has more to do with habits and muscle control, that is when pelvic floor therapy can help.

How Pelvic Floor Therapy Can Help

The therapists at Fusion Wellness and Physical Therapy/Femina can help your kid get past constipation issues, as well as urinary/fecal accidents.

Our pediatric protocol is minimally invasive and involves a lot of patient and parent education. We typically do not do internal examinations or interventions until all external options have been exhausted.

What types of treatments you can expect with pediatric pelvic floor therapy:

• Therapeutic Exercises
  • We will teach your kiddo a variety of exercises to strengthen and stretch the pelvic floor muscles so they can feel confident in their ability to control both bowel and bladder issues.

• Neuromuscular Re-Education
  • We will help your kid’s brain and muscles coordinate correctly so that you are actually relaxing your muscles when you think you are relaxing them.
  • 40% of people with constipation have a muscle coordination issue where they are actually squeezing their pelvic floor muscles when they think they are relaxing them. This issue is called dyssynergic defecation, read more about it at the Femina Blog.

• Toileting ergonomics
  • Believe it or not, there is a right way and a wrong way to poop. Our therapists have kid friendly ways of teaching the skills of successful pooping that your kiddo will have for the rest of their lives

• Relaxation and Breathing Exercises
  • In order to have a bowel movement, the body must relax the anal sphincters and pelvic floor muscles. At the same time, the body must create enough over pressure to help facilitate the evacuation. Using breathing and relaxation exercises, we will teach your kid how to master these techniques.

• Abdominal massage
  • Taught to parents and child, tummy massage techniques facilitate bowel movement

• Myofascial Release
  • Using manual therapy to address abdominal and pelvic girdle muscles that can be tight or in spasm, causing

The ultimate goal is to help the child to be able to fully relax the pelvic floor and have a complete bowel movement without strain or pain.

Give the therapists at Fusion Wellness and Physical Therapy a call today!

Resources

Caperell, K., Pitetti, R., & Cross, K. P. (2013). Race and acute abdominal pain in a pediatric emergency department. Pediatrics, 131, 1098-1106.

Mugie, S. M., Benninga, M. A., & Di Lorenzo, C. (2011). Epidemiology of constipation in children and adults: A systematic review. Best Practice & Research. Clinical Gastroenterology, 25, 3-18.

Philichi, L. (2018). Management of Childhood Functional Constipation—Continuing Education Posttest. Journal of Pediatric Health Care, Volume 32, Issue 1, January–February 2018, Pages 112-113 https://www.sciencedirect.com/science/article/pii/S0891524517301311

Rajindrajith S, Devanarayana NM, Crispus Perera BJ, Benninga MA. Childhood constipation as an emerging public health problem. World J Gastroenterol. 2016;22(30):6864-75 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974585/

Xinias I, Mavroudi A. Constipation in Childhood. An update on evaluation and management. Hippokratia. 2015;19(1):11-https://www.ncbi.nlm.nih.gov/pubmed/26435640

**