Paediatric Pelvic Health

What are the symptoms to watch for?

Symptoms of pelvic health concerns vary dramatically between adults and children and also from case to case. It is important to be aware of your children’s typical bladder and bowel habits and if they start to change (keep reading for normal bladder and bowel habits in children).

Bladder Symptoms

• Urinary Incontinence (day or night)
• Postponing Voiding
• Incomplete Emptying
• Straining to Void
• Decreased urinary urge
• Fear of voiding
• Leaking with jumping, running or laughing
• Increased frequency (more than 8x/day)
• Decreased frequency (less than 4x/day)

Bowel Symptoms

• Abdominal Pain
• Faecal Staining
• Straining to empty
• Large diameter bowel motions
• Persistent small snake-like bowel motions
• Refusal to open bowels on toilet
• Infrequent bowel motions (3+ days)
• Blood in stool

What is ‘Normal’?

Babies will typically have small voids every 1-2 hours. Typically by 5 years old children should be continent both day and night with an increase in their bladder capacity and voiding volumes.

A normal frequency for children over the age of 5 is between 4-7 times per day or every 3-4 hours. In regards to our bowels, the frequency of bowel movements should decrease with age until 4 years old. By age 4 bowel motions will be on similar timings to adults with regular motions anywhere from 1-3x a day or once every 3 days (between 4-9 BM a week).

What conditions can Pelvic Physio help with?

Physiotherapists can help with many pelvic health concerns that may occur in children. This includes;

• Constipation
• Enuresis (daytime wetting)
• Nocturesis (bed wetting)
• Faecal Staining/ Incontinence
• Stress Incontinence/ Giggle
• Incontinence
• Overactive Bladder
• Underactive Bladder
• Post Void Dribble
• Holding/ Postponement of
• Voiding
• Toilet Training (fears, regressions, difficulties to progress)
• Incomplete Emptying

Do I need a referral or other testing before physiotherapy assessment?

No pre-testing or referral is required to see Pelvic Paediatric Physiotherapists in Australia. You can book online via our website or call the team directly to discuss assessment options. After your initial review, the Physiotherapist may recommend further assessment through your GP or specialists if required to diagnose or treat your child.

What to expect during your child’s initial assessment?

There will be lots of talking during the assessment, especially the initial assessment. It will be important to gather general history of the child, medical histories, toileting behaviours and a thorough symptom analysis from you and your child. The Physiotherapist will spend as much time as possible talking directly to the child (if appropriate age) during the session as it is important for the child to be involved in their assessment and treatments to achieve the best results. Sometimes this means we might have to call the parent after or before the session to gather all the information.

External palpation/EMG – If the Physiotherapist needs to assess your child’s pelvic floor this can be done typically in two ways:

1. Via external palpation near the ischial tuberosities (sitting bones)
2. With surface EMG assessment where you or the therapist place electrodes on the child’s skin near the perineum to assess for correct activation and relaxation of the pelvic floor.

This will most likely not occur in the first session but might be discussed with you and your child in later sessions. Only with permission of the guardian and child will any assessments occur.

Other assessments that might be required could be bladder diaries, food diaries, abdominal palpation, postural and musculoskeletal assessments and/or reflex testing for neurological assessment.

There are no internal assessments required to assess your child’s pelvic floor.

Treatment Types

Education: A large amount of education is required for bladder and bowel management in children. Depending on the specific concern education may range from toilet training, bowel habits and sensation, water intake or bladder retraining. There are many factors that affect a child’s bladder and bowel development. Depending on the child, multiple people may need to be involved in the education sessions including parents/guardians, babysitters, grandparents, other family members, teachers etc. There is a great variety of books for all reading levels about multiple bladder and bowel concerns that are great for teaching children about their body and how to help themselves as well.

Behavioural Modifications: Certain habits are formed that cause bladder or bowel symptoms and we need to teach the child to break the habit and create new ones. This type of treatment can take time and therefore requires patience and practice.

EMG: If the child is experiencing constipation due to an overactive or paradoxical (out of coordination) pelvic floor, then electromyography can be very beneficial. When using EMG it provides feedback to assess pelvic floor contraction and relaxation by ways of vibrations or visual aids (computer based games can be great for a child’s willingness to participate)

TENS: Peripheral electrical stimulation can help children with a variety of bladder and bowel symptoms (specifically faecal incontinence or overactive bladder). The pads that deliver the impulses are typically placed near the sacrum or on the ankle to deliver the therapy.

Equipment: There is a large range of equipment out there that can help children with bladder and bowel symptoms. Some of the recommended equipment might include; specific toilet
seats, foot stools, bedwetting alarms, watches with set alarms, TENS machines and more.

Medications: Depending on the reason for the symptoms sometimes medications may be
recommended to help. Seeking advice from your Paediatrician or GP regarding medication can be very helpful to get on top of symptoms.

Final Points

There are many ways that Pelvic Physiotherapy can help children suffering from bladder or bowel concerns.

It is important to act quickly to reduce the likelihood of the symptoms becoming chronic.
We aim to educate the child alongside all carers involved to achieve optimal results, as research has shown that the children who demonstrate a better understanding of how and why they need to be involved have more positive outcomes.

Bladder and bowel symptoms can occur at any age of a child’s life and we are here to help children at all different stages whether it be for babies who are constipated, toddlers with toilet training, school aged children with new onset symptoms or adolescents when our hormones start to affect our functioning.
It takes a village to help care for a child and there are many people out there willing to help you and your family.

Written by our Women’s Health and Paediatric Physiotherapist, Kaitlyn Steinhardt.