Overcoming Bowel and Bladder Challenges at School: The Role of Pelvic Floor Physical Therapy

By Dr. Erica Mitchell, PT, DPT

For many parents, the morning routine of getting their children ready for school involves more than just packing lunches and tying shoelaces. Some parents find themselves dealing with the challenges of children withholding bowel and bladder at school. This issue can be emotionally distressing for both parents and children, affecting the child’s well-being, social interactions, and academic performance. However, there’s hope on the horizon, and pelvic floor physical therapy is emerging as a valuable ally in addressing these concerns.

Understanding the Issue:

Withholding bowel and bladder is a common problem among school-aged children, and it can manifest in various ways. Children may resist going to the bathroom, experience constipation, or even exhibit signs of anxiety related to toilet habits. These challenges can lead to physical discomfort, social embarrassment, and an overall negative impact on a child’s quality of life.

Causes of Withholding:

Several factors can contribute to children withholding bowel and bladder at school. These may include anxiety, fear of using public restrooms, developmental delays, sensory issues, or underlying medical conditions. Addressing these issues requires a comprehensive approach, and pelvic floor physical therapy is an effective approach.

The Role of Pelvic Floor Physical Therapy:

Pelvic floor physical therapy is a specialized form of physical therapy that focuses on the muscles, ligaments, and connective tissues that support the pelvic organs, including the bladder and bowels. When children experience difficulties with bowel and bladder control, pelvic floor physical therapists work to assess and address any dysfunctions within these muscle groups.

Pelvic floor physical therapists conduct a thorough evaluation to identify any weaknesses, imbalances, or abnormalities in the pelvic floor muscles. This assessment helps tailor a personalized treatment plan for each child.

Biofeedback is one available tool through pelvic floor physical therapy. It involves any visual and tactile cue to the child that they are contracting and/or relaxing their pelvic floor muscles. This helps them gain awareness and control over their pelvic floor muscles, facilitating improved bowel and bladder function.

Pelvic floor physical therapists design exercises that target specific muscle groups, promoting strength, flexibility, and coordination. These exercises are often incorporated into a child-friendly routine, making the therapy engaging and effective.

Beyond physical exercises, therapists may employ behavioral strategies to address psychological factors contributing to withholding behaviors. This may involve education, relaxation techniques, and counseling to help children manage anxiety related to toileting.

Here are just a few potential benefits to pelvic floor physical therapy:

Improved Bowel and Bladder Control:

  • Through targeted interventions, pelvic floor physical therapy helps children regain control over their bowel and bladder functions, reducing instances of withholding.

Enhanced Confidence and Well-being:

  • As children gain mastery over their pelvic floor muscles, they often experience increased confidence, improved self-esteem, and a more positive outlook on daily activities.

Prevention of Long-Term Issues:

  • Pelvic floor physical therapy addresses underlying issues, preventing the development of long-term complications associated with bowel and bladder dysfunction.

Conclusion

The journey of overcoming bowel and bladder challenges at school is undoubtedly a challenging one for both parents and children. However, pelvic floor physical therapy is a valuable intervention, and with that there is hope for positive change. By addressing the physical and psychological aspects of withholding behaviors, pelvic floor physical therapy empowers children to enjoy a healthier, more confident, and fulfilling school experience. If your child is facing these challenges, consider consulting with our pediatric pelvic floor physical therapist to explore personalized strategies for improvement and long-term well-being.

Dr. Erica Mitchell, PT, DPT, is a Pelvic Floor Therapist who has extensive training treating pediatric pelvic floor dysfunction. She treats clients in the Magic City Physical Therapy office in Hoover, Alabama, and is also available for virtual consultation.

Why Does My Child Refuse to Use the Toilet?

by Erica Mitchell, PT, DPT

It’s not uncommon for children to have aversions or fears related to using the toilet, particularly when it comes to pooping. This issue, known as fecal withholding or stool toileting refusal, is more prevalent than most people think. Some children find it uncomfortable, frightening, or simply prefer the familiarity and security of a diaper.

Factors contributing to this aversion can include:

  • Fear of the toilet: The size, noise, or fear of falling in can make a child anxious.
  • Pain or discomfort: Past experiences of constipation or painful bowel movements might make them avoid going.
  • Control and autonomy: Some children resist the idea of being told when and where to use the toilet, asserting their independence.
  • Anxiety or stress: Changes, such as starting school or other life events, can trigger toilet-related anxiety.
  • Sensitivity or sensory issues: Some children have sensory processing issues that make certain experiences, like sitting on the toilet, uncomfortable.

If you’re facing this issue, it might be beneficial to:

  • Be patient: Pressuring or punishing can exacerbate the problem.
  • Create a positive environment: Make the toilet a comfortable, positive place. Use books or toys to make it more inviting.
  • Establish routines: Regular toilet times can help.
  • Seek professional help: If the aversion persists, consulting a pediatrician, child psychologist, or pelvic floor physical therapist can provide guidance tailored to your child’s needs.

There are also consequences due to toilet aversion with a common problem being constipation from withholding stool. This occurs when a child intentionally avoids passing stool, often due to fear or discomfort associated with bowel movements. They may withhold stool for various reasons with toilet aversion being possible.

The longer stool remains in the colon, the more water is absorbed, making it harder and more painful to pass. This creates a cycle where the child becomes more fearful of passing stool due to the associated discomfort, which further exacerbates the constipation.

To address constipation due to withholding stool, here are some steps you can take:

  • Encourage a healthy diet: Ensure your child gets plenty of fiber from fruits, vegetables, and whole grains. Adequate hydration is also important.
  • Establish a routine: Encourage regular toilet habits after meals, as the body’s natural reflexes are often stronger then.
  • Create a comfortable environment: Make the toilet experience more pleasant by using a stool or step for their feet, making sure it’s warm and inviting.
  • Encourage relaxation: Teach relaxation techniques like deep breathing to ease anxiety associated with bowel movements.
  • Consult a professional: If the issue persists or causes significant distress, consulting a pediatrician or a pelvic floor physical therapist can provide tailored advice.

Patience and understanding are crucial when dealing with constipation related to stool withholding. It’s essential to create a supportive and understanding environment for your child and avoid punitive measures, as these can exacerbate the issue.

Remember, every child is different, and what works for one may not work for another. If this becomes a significant concern or if it’s causing distress to your child, seeing a pelvic floor physical therapist with pediatric experience can help. Call us for a consult today!

How to Encourage Fiber in Your Child’s Diet

By Erica Mitchell, PT, DPT

Encouraging fiber in your child’s diet is a great step toward preventing constipation and promoting overall digestive health. Here are some child-friendly ways to incorporate fiber:

  • Fruits and vegetables: Offer a variety of colorful fruits and vegetables. Berries, apples, oranges, bananas, carrots, broccoli, and sweet potatoes are excellent choices. You can serve them as snacks or incorporate them into meals.
  • Whole grains: Choose whole-grain versions of bread, pasta, and cereals. Look for labels that mention “whole grain” or “whole wheat” as the first ingredient.
  • Legumes: Beans, lentils, and peas are high in fiber. You can include them in soups, salads, or as a side dish.
  • Nuts and seeds: Almonds, walnuts, chia seeds, and flaxseeds are good sources of fiber. Be mindful of choking hazards and give them in appropriate portions based on your child’s age.
  • Hydration: Ensure your child drinks plenty of water throughout the day. Fiber works best when paired with adequate fluids to help with digestion.
  • Smoothies: Create delicious smoothies by blending fruits, yogurt, and a handful of spinach or kale (which can be masked by the fruits’ flavors).

When introducing new foods, be patient. Children might need time to adjust to new tastes and textures. Making meals colorful, visually appealing, and involving your child in meal preparation can increase their interest in trying new foods.

Gradually increasing fiber intake is essential. Rapidly introducing large amounts of fiber can cause bloating or discomfort. If your child is not used to a high-fiber diet, it’s advisable to incorporate it slowly into their meals.

Signs of inadequate fiber in a child’s diet can manifest in various ways. Some common signs include:

  • Constipation: One of the most apparent signs is infrequent or difficult bowel movements. Stools may be hard, dry, or painful to pass.
  • Digestive issues: Your child might experience abdominal discomfort, gas, or bloating. They might complain of stomach aches or feel generally uncomfortable after eating.
  • Irregular bowel movements: If your child doesn’t have regular bowel movements or has irregular patterns, it could indicate a lack of sufficient fiber.
  • Low energy levels: Inadequate fiber intake might impact energy levels. Your child might seem fatigued or have less energy than usual.
  • Poor appetite: Lack of fiber can sometimes affect appetite, leading to reduced interest in eating or mealtime reluctance.
  • Weight management issues: A diet low in fiber might contribute to weight-related concerns, either overweight or underweight, as fiber helps with satiety and regulates appetite.

It’s important to remember that these signs can also be caused by various other factors. However, if you notice several of these signs in your child and suspect a lack of fiber in their diet, consider reassessing their food choices.

Increasing fiber intake gradually and ensuring a well-rounded, balanced diet that includes fruits, vegetables, whole grains, and legumes can help address these concerns. If you’ve noticed irregularity in bowel movements or chronic constipation in your child, they could benefit from a pelvic floor physical therapy consultation to work with parents and the child to optimize nutrition and habits to improve overall gut health!

 

Bladder Problems in Kids

By Erica Mitchell, PT, DPT

Bladder problems in children can vary and might include:

  • Urinary Tract Infections (UTIs): UTIs are common and occur when bacteria enter the urinary tract. Symptoms can include frequent urination, pain or burning during urination, abdominal pain, foul-smelling or cloudy urine, and sometimes fever.
  • Bedwetting (Nocturnal Enuresis): This is involuntary urination during sleep. It’s common in younger children and often resolves by age 6. However, it can persist in some children and might be due to factors like stress or constipation.
  • Overactive Bladder (OAB): Some children might experience an overactive bladder, which causes a sudden, uncontrollable urge to urinate, leading to accidents.
  • Voiding Dysfunction: This includes difficulties in controlling the flow of urine or emptying the bladder completely. It might involve holding urine for too long, resulting in accidents or urinary urgency.
  • Structural issues: Rarely, children might have structural problems affecting the bladder or urinary tract, such as abnormalities in the urinary system.
  • Neurological conditions: Conditions affecting the nerves that control the bladder can lead to bladder problems in children.

Pelvic floor physical therapy can be beneficial for pediatric bladder problems in certain cases. Pelvic floor physical therapy focuses on the muscles, ligaments, and connective tissues in the pelvic area, aiming to improve function and alleviate issues related to the pelvic floor.

In children, pelvic floor physical therapy can be used to address various bladder problems, including voiding dysfunction, bedwetting, and overactive bladder. Techniques taught in pelvic floor therapy, such as bladder retraining and relaxation exercises, can assist in managing symptoms of these dysfunctions. Your pelvic floor physical therapist can also offer advice on toileting habits, fiber intake, and provide external modalities to improve overall bladder and bowel function.

Pediatric pelvic floor physical therapists approach treatment very differently from how it’s done with adults. In the case of children, especially younger ones, the approach is non-invasive and does not involve internal work like it might with adults.

Pediatric pelvic floor physical therapists primarily use external techniques and methods that are age-appropriate and comfortable for children. These techniques might involve:

  • Education: Teaching children about their pelvic floor muscles and bladder function in a child-friendly manner.
  • Behavioral Strategies: Implementing behavioral strategies and exercises that help children improve bladder habits, relaxation, and coordination of pelvic muscles.
  • Biofeedback: Using non-invasive techniques to help children understand and control pelvic floor muscle activity.
  • Therapeutic Activities: Engaging children in play-based or age-appropriate activities that indirectly support pelvic floor function.
  • Posture and Positioning: Teaching children proper sitting and voiding positions to aid in bladder emptying.

The approach is gentle, supportive, and often involves play or activities to make therapy sessions more engaging for children. Your therapist will collaborate closely with the child and their caregivers to create a comfortable and effective treatment plan.

The aim of pediatric pelvic floor physical therapy is to improve bladder and bowel function, alleviate symptoms, and empower children and their families with tools to manage and improve bladder health without causing discomfort or stress.

Dr. Erica Mitchell, Pelvic Floor Physical Therapist, has extensive training in the treatment of Pediatric Pelvic Floor Dysfunction with a background in Pelvic Floor Dysfunction for women and men.