Complete Guide to Pediatric Pelvic Floor Therapy

Pelvic floor therapy is for all people: men, women, boys & girls. Seldom do we consider what our children’s pelvic floor health is like or if their toileting habits are healthy, often not considering until there is difficulty.

Pelvic floor therapy addressed a number of aspects for the pediatric population including: bedwetting (noctural enuresis), pee accidents after potty training, not wanting to use the toilet, constipation or trouble consistently having an easy bowel movement, needing to go pee or poop very frequently or urgently. Often times the pelvic floor and our habits are a main driver of this very easily correctable issue.

How does the pelvic floor impact urination & bowels?

The pelvic floor is the group of muscles, nerves, and connective tissues that create a hammock between the pelvic bones. The pelvic floor must be able to contract fully to hold pee and poop in, then relaxes to release urine or bowels.

If the pelvic floor is too tense it crowds the bladder, decreasing the ability to fill comfortably. Therefore sending you to the bathroom urgently before it is completely full. The pelvic floor muscles must be able to strong enough to counteract the weight of the filling bladder to keep your little one dry after potty training.

For BMs, our muscles have to be strong enough to hold until seated on the toilet- but- have to have enough length to relax to let the poop through. Sometimes what we see are pencil-thin bowels, this can be caused by a lack of fiber in the diet- or tense muscles.

Pelvic floor physical therapy or occupational therapy works to address the root cause- allowing pee and poop to be held and then fully released when its time.

How often should children pee or poop?

The ranges are large, we look for consistency within this range to establish your own norms. Bowel movements should happen anywhere from 3 times a week to 3 times a day. Bowls should be smooth in texture, without cracks-resembling a sausage or banana. Any small pebble looking bowels signal constipation.

Urination should occur every 2-4 hours for about 7-9 seconds in duration. Urine should be a light yellow to clear color, anything bordering on the dark yellow, orange, or amber colors often signify we need a lot more fluids.

As a parent what can I do to help?

As a parent, you play the largest role in your child’s toileting success. Most prominent is to keep consistent and low pressure on approaching the toilet and accidents.

Keeping sitting on the toilet low pressure decreases toilet avoidance and withholding. When approaching the toilet if filled with anxiety or fear it is so hard to be able to relax and lengthen the pelvic floor muscles for evacuation.

Our bodies are trainable, especially the bowels. Creating predictable times for our bodies to eliminate can be very helpful. All too often we get stuck in the rush of routines, getting the kids up- fed- and out the door. All before they are able to have a good calm opportunity to sit on the toilet for a bowel movement. Incorporating time does not need to be a long lengthly tasks, at Bloom Pelvic Therapy we recommend sitting on the toilet for no more than 5-6 minutes at a time, anything beyond that is often not productive. Instead, we recommend going about your day or routine and returning when the urge calls.

Why are hydration and food choices important?

Hydration and nutrition are also paramount to good urination and bowel movements. Water and fiber help to form the stools and move them along to maintain regularity. A dehydrated child often will have harder bowels as more water is removed from the intestines. Both soluble and insoluble fiber is essential in daily foods. Each day, aim for 4-6 cups of water & 9-15 grams of fiber

Fiber in the diet needs to include both soluble and insoluble fibers- one acts to bulk the stools, the other to move it along. There are a variety of ways to incorporate fiber in their diets- including more fiber-dense fruit salad- such as apple, pear, or raspberries, oatmeals, high-fiber cereals, or popcorn.

How can you set up the bathroom for success?

Often times the bathroom can be intimidating, especially when paired with pee or poop difficulties. Making the bathroom a place for safety and relaxation is essential.

In addition, a place they can sit securely, without a fear of falling into the bowel assists the pelvic floor muscles in relaxing.

Using a squatty potty or stool under the feet, getting the knees above hip level mechanically allows the muscles to lengthen, facilitating elimination.

If your child is sitting on the toilet for longer than 5-6 minutes, it’s too long. Have them get off the toilet, go back to typical activities, & return to sit when the urge to go happens again.

What pediatric concerns can pelvic floor therapy address?

* Bed Wetting

* Constipation

* Avoidance of BMs on Toilet

* Needing to go urgently

* Difficulty holding urine or bowels

* Difficulty starting or keeping the flow of urine

For more information on pelvic health, related concerns, and other helpful tips we wrote a large blog “The Complete Guide to Everything to Know about Your Pelvic Floor Health and Pelvic Floor Therapy”