Pediatric Pelvic Health: A Pediatric Pelvic Health Physical Therapist’s Advice

Difficulty with bowel and bladder control can be quite an emotional situation and journey for both the parent(s)/guardian(s) and child. It can be difficult to figure out the who, what, when, where and why of the situation.

  • Who should I reach out to?

  • What is the cause of the problem?

  • When is the right time to seek help?

  • Where should I look for care?

  • And why is this happening?

It may take some time to address these questions but these are the first steps to determine where to get started in order to improve your child’s situation. It’s often difficult to understand the dysfunction that occurs with bladder and bowel health, but you and your child are not alone. Around 20% of pediatrician visits are for incontinence problems and around 15% of gastrointestinal medical doctor visits are for bowel dysfunction, such as constipation.  Children are not immune from issues such as:

  • Urinary or bowel leakage - daytime or nighttime

  • Urinary retention

  • Urinary frequency/urgency

  • Bowel frequency/urgency

  • Constipation

  • Overactivity of the bladder

  • Pelvic pain

It’s just a matter of where to start first.

Who should I reach out to?

The first point of contact should be your child’s pediatrician. Hopefully they have been following your child’s development and have made you aware that by 5 years of age we would expect good bowel and bladder control to be in place. They may refer you to urologists or gastroenterologists, and that’s great. We encourage parent(s) or guardian(s) to seek advise from multiple health care practitioners to ensure there are no underlying problems that may need to be addressed immediately.

After checking with your child’s physician, you should consider reaching out to a pelvic health physical therapist. Pelvic health refers to the most optimal function of the bladder and bowel. And this impacts one’s social, emotional and physical health. This involves not only determining and treating what’s taking place, but also improving the daily functional habits, schedules, and routines to improve you and your child’s quality of life.


What is the cause of the problem?

The issues listed above may have multiple origins which is why seeking a medical provider is important. However, typically the issues correlate to pelvic floor dysfunction as the cause or potentially a huge contributing factor. The pelvic floor is composed of a group of muscles that lay like a sling at the bottom of our pelvis. These muscles function just like any other part of our body, except they have different roles and responsibilities. Just as you use your arm muscles to help lift and hold objects, the pelvic floor muscles work with the same mechanics. However, instead these muscles help with bladder and bowel control for not only children, but for individuals of all ages.

For example, when these muscles contract, they assist with holding back the bladder or bowel from emptying, and when they relax, they are in the position to allow the bladder or bowel to empty.

When these muscles are not at their optimal function, this can cause the opposite reactions to happen at the wrong times. For example, urinary retention can occur when these muscles contract prematurely while peeing, causing urine to be retained. This can cause problems such as incontinence or urinary tract infections. Or, for example, when the muscles are weak and not able to contract appropriately when your child is jumping, they can cause some unwanted urine to pass. These examples demonstrate a few parts of care that can be addressed by a pelvic health physical therapists, that do not require any invasive treatment or medication.


When is the right time to seek help?

By around 5 years of age, it is expected of a child to have bladder and bowel control. However, this can vary greatly by neurological development, physical development and emotional development.

Regardless, it would be beneficial to reach out at this time for assistance or further assessment. If at this time your medical doctor feels like it may continue to take some time to develop, it may be a good time to seek out a pediatric pelvic health physical therapists to determine if pelvic physical therapy can help progress your child’s current state.

Where should I look for care?

Your pediatrician will be a good starting point as mentioned. However, finding a pelvic health physical therapists will encourage a route that is focused on interventions to address pelvic floor muscle control. Luckily, living in New Jersey you do not need a prescription to access physical therapy. We are a Direct Access state and can perform an initial evaluation as soon as necessary.


Why is this happening?

You are not alone. Just as someone may have neck pain, and have radiating headaches, or weak ankle muscles, that can trigger the onset of tendinitis, this region of the body is no different, except problems can translate into different forms of dysfunction. A pediatric pelvic health physical therapists has undergone specific training to improve bladder and bowel function, just as an orthopedic physical therapists has training on returning to sport or walking.

Please feel free to reach out to the therapists of Inner Dynamics Physical Therapy for any assistance, or specific questions to address your child’s pelvic health. Thank you.


Tamra Wroblesky