Pediatric Pelvic Floor Therapy: What To Expect on the First Visit

Pelvic floor issues including constipation and incontinence can affect kids as well as adults. At Fusion Wellness & Physical Therapy our therapists work with you and your child to make a safe and comfortable environment to treat these common issues to help your child function at their best and prevent pelvic floor issues in later childhood and adulthood.

The first visit is a thorough 90 minute evaluation, this gives the therapist time to get to know the parent and child as well as complete a thorough evaluation. Pelvic floor conditions, especially in the pediatric population can be complicated- there are many factors which could be contributing to the problem including chronic constipation, bowel/bladder habits, movement patters, toileting positioning, among other things. Once we understand the root causes your child's pelvic floor issue, we will come up with a treatment plan to help your child feel better and get back to the activities that they care about like school and recreation.

These days, getting 90 minutes alone with a practitioner is pretty rare. At Fusion Wellness & Physical Therapy, we believe in the importance of having time to get to know you and your child, understand the complete medical history, perform a thorough orthopedic exam, as well as a pelvic floor exam.

In this article we will outline exactly what to expect on a first visit for a pediatric client.

Part One: Listening to Your Story and Education About Pelvic Floor Therapy

Therapists will interview both the parent and the child regarding symptoms, issues, and medical history. We want to tease apart what the different layers are that may be contributing: bowel/bladder habits, diet, orthopedic or sensory issues.

Our therapists will then educate both you and your child about pelvic floor therapy (don't worry, we can do it in a kid-friendly and parent-friendly way). What is the pelvic floor? What does pelvic floor therapy look like? How will this therapy help? We will address any questions and concerns at this point so both you and your child understand how we can help. 

Part Two: The Orthopedic and Whole Body Assessment

Most pelvic floor conditions involve other parts of the body. At Fusion Wellness and Femina Physical Therapy, we believe in treating the whole person, not just individual areas or muscle groups.

Following the discussion of medical history, your therapist will screen the entire body of your child, looking for tight muscles, dysfunctional movement patterns, neuropathic, and orthopedic issues that might be playing a part in your pelvic floor issue.

We will evaluate your posture, pelvis position, hip and spine flexibility and range of motion, position of the sacrum, and muscle tone throughout your abdomen, back, hips, glutes, and thighs.

Part Three: The Pelvic Floor Assessment

After your orthopedic exam an external evaluation of the pelvic floor muscles will be performed with your informed consent.

Our pediatric pelvic exams are external.

The therapist will leave the room so that your child can undress from the waist down and put on an examination gown. After the therapist returns to the room they will perform an external pelvic floor examination.

This will begin with a skin check, looking for any irritation or dryness of the tissues. After that, there will be an external palpation of the pelvic floor muscles from the outside, the therapist will palpate around your pubic bone and sitting bones, assessing pelvic floor activity and looking for dysfunction. After palpation, the therapist may ask your child to do a kegel (contract the pelvic floor muscles as if you are stopping the flow of urine) and they may also ask your child to bear down as if you are passing gas or a bowel movement. This is in order to see if muscle control is normal and to screen out possible conditions such as dyssynergic defecation (read my blog about that by clicking the link).

All the therapists are very compassionate and will constantly checking in with both the parent and child, to ensure comfort and safety.

Part Four: Treatment on the First Visit

Since our evaluations are a full 90 minutes, there is often time to start treatment on your first visit. Your therapist will communicate to you what they are finding and will start treatment that day, often prescribing you some “homework” to work on right away, to start improving your condition.

What does the treatment look like?

Pelvic floor physical and occupational therapy is a great option for kids with toileting issues, because treatments pose a low risk of side effects and treatment can be very effective.

The physical and occupational therapists at Fusion Wellness and Physical Therapy can help kids with incontinence and pelvic floor dysfunction in the following ways:

• Patient Education: educating the child and parent in the bowel and bladder, listening to body signals, positioning, and hygiene.
• Identifying behaviors that may be contributing to the problem:  the child and parent will complete a voiding diary that tracks diet and toileting habits for a few days. With the help of the therapist, the child and parent will start to see patterns of behavior and dietary factors that may be making the problem worse. 
• Bowel management: The therapist will teach the child and parent regarding hydration, dietary factors, proper toileting positioning, and proper pushing technique to relieve constipation which may be contributing to pelvic floor dysfunction.
• Pelvic floor biofeedback:  Biofeedback is a medical technology used in pelvic floor therapy that helps the brain and body re-establish healthy coordination patterns. Computer sensors are used to measure activity of the pelvic floor muscles while a screen gives live visual feedback as to what the pelvic floor muscles are doing. From the perspective of the patient, it basically looks like you are playing a video game with your pelvic floor. With this “game” the client is taught how to properly contract and relax the pelvic floor. Additionally, it is used to train proper pushing technique. Correct function of the pelvic floor is essential for both bowel and bladder function. This study by Richardson and Palmer (2009) shows that biofeedback is a safe and effective intervention for kids with voiding dysfunction.
• Manual therapy including soft tissue massage, connective tissue manipulation, muscle energy techniques, and myofascial release to treat connective tissue dysfunction and myofascial trigger points
• Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to improve motility and GI organ function

Pediatric pelvic floor issues can lead to more serious symptoms later on in life. Help your child get on track with normal bowel and bladder function. Let the therapists at Fusion and Femina Physical Therapy help you along the journey back to wellness and function! Make an appointment today and let’s get started.