Pediatric Pelvic Health Physiotherapy

• Urinary incontinence (often called leaking urine or bladder leakage): day time leaking due to sneezing, laughing, giggling, holding pee too long, etc.
• Frequent urination: the need to go to the bathroom quite frequently or very urgently (overactive bladder)
• Night time bedwetting (Enuresis)
• Constipation or stool retention
• Fecal (Stool) leaking/incontinence
• Holding pee (Under-active bladder or urinary retention)
• Painful bowel or bladder movements
• Pain in the groin or rectal area
• Muscular tightness/imbalance and joint stiffness or pain (often as a result of sport or play)

We will work with the whole family: It is important that both you and your child feel comfortable and supported throughout the process. We invite the participation of you and your child during all assessments and treatments. We will keep things relaxed and engaging for your child. It’s important for my work to hear both your perspective and your child’s perspective.

We begin with a thorough health history interview: I will ask about the reason for your
accessing of pelvic physio, the challenges you and your child have experienced, any official
diagnoses or medical testing they’ve received, your concerns, your and your child’s goals
and hopes, any strategies tried so far, and your child’s overall development. I will use
questionnaires as well as a bowel/bladder diary to help gather information.

We continue to do an external physical exam: I will evaluate your child’s posture and breathing, joint mobility, muscle length, strength and control. With your and their consent, the therapist will likely want to evaluate the external pelvic floor muscles to determine your child’s  ability to contract or relax the pelvic floor (your child will remain fully clothed for this part of the evaluation).  This is done visually and/or with some palpation.  Unlike adults, there is usually NO internal examination of the pelvic floor muscles for children – unless medically indicated and requested for older children (which will be discussed with you and your child, written consent will be required, etc).

We send you home with a plan: I will develop a program of care for you and your child. This may include some small changes to your home (ex: installing a different toilet seat, using a step stool next to the toilet, leaving some favorite toys or books in the bathroom, the use of a timed watch, etc), an exercise program that we will practice together, and will likely include a log for tracking your child’s progress.

Treatment is individualized and based on the findings of the evaluation, and most importantly, on your child’s and family’s goals. Treatment may include:

• Education – giving you the tools and understanding as to what, how and why these conditions are happening
• Bowel or bladder scheduling (via reminders, timed voiding, journaling, etc)
• Getting your child familiar with their pelvic floor muscles
• Training for the pelvic floor muscles
• Brainstorming helpful strategies to try at home such as positioning, behaviour modification, cueing, language/phrasing, diet adjustments, sleep training, and more
• Constipation management!
• Skin care/wiping techniques
• Exercises to retrain or relax the pelvic floor
• Manual therapy (external only) on the rib cage, belly or joints of the lower body and pelvis, or the external pelvic floor
• Collaborating with the rest of your child’s care team (ie. family doctor, etc)
• A home program