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Montgomery, PA 17752
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Urinary and fecal incontinence in children
Most children have conscious awareness and control of their bladder and bower function, having only occasional episodes of unintentional voiding, by age 4. But for those who struggle with dysfunction of their bowel and bladder beyond the age of 4, childhood can be quite difficult. Not only might they feel ashamed of themselves and face ridicule from other children, but many often face disciplinary action at home or at school. The problem goes well beyond these social implications, as bowel and bladder dysfunction is a serious medical concern in children older than 4. If not resolved, pediatric incontinence can significantly affect quality of life for the child and their family.
There are several “umbrella terms” commonly used to describe difficulty with bowel and/or bladder control in children; these include Pelvic Floor Dysfunction, Bladder Bowel Dysfunction, Dysfunctional Voiding and Dysfunctional Elimination Syndrome. Below is a list of some common diagnoses that fall within the realm of these terms:
Urinary Diagnoses and Symptoms
- Daytime urinary incontinence
- daytime wetting/leaking
- stress incontinence
- urge incontinence
- Bedwetting / Nighttime urinary incontinence (nocturnal enuresis)
- Giggle incontinence
- Overactive bladder / Urinary frequency & urgency
- Urinary retention / Incomplete bladder emptying
- Frequent Urinary Tract Infections
- Vesicoureteral reflux
- Painful urination
how physical therapy can help
Physical therapy can be quite helpful for children who have been diagnosed with any of the above conditions or those demonstrating any of the following symptoms:
- Unintentional passage of urine or stool
- Underwear that are damp or have soft stool or streaks
- Frequent "close calls" when heading to the toilet or frequent use
- Frequent use of avoidance techniques such as standing on tip toes, crouching down, crossing legs, or dancing
- Burning or pain during voiding
- Frequent UTIs
(Please note that physical therapy cannot help or improve symptoms or problems related to neurogenic bladder related to nerve damage or certain neurologic conditions.)
There are two things to remember about physical therapy treatment for Bladder Bowel Dysfunction:
- We will always address the daytime problems first in children who have daytime and nighttime difficulties! Profound improvement is often seen in overnight symptoms as daytime symptoms improve.
- Effective treatment of constipation, even if it does not appear to be symptomatic or problematic, often results in dramatic improvement of urinary symptoms; failure to address constipation often results in little to no improvement in urinary voiding dysfunction.
PHYSICAL THERAPY TREATMENT MAY INCLUDE:
- Management of constipation or other bowel problems. Constipation generally goes hand in hand with overactive bladder and/or urinary incontinence issues, with many urinary symptoms lessening or resolving when constipation is successfully managed. Successful management of constipation often includes development of good toileting routines and habits, use of advantageous sitting position on the toilet and better dietary habits.
- Coordination, retraining and/or strengthening of pelvic floor muscles. Some children experience contraction and/or relaxation of their pelvic floor muscles at the wrong times when they are trying to empty the bladder or bowels; this confuses the rest of the body and often interferes with voiding. We are able to use various techniques, including surface biofeedback, to help retrain and/or strengthen the pelvic floor muscles and help them work better with the bowel and bladder.
- Daytime bladder retraining and routines. Daytime bladder retraining is essential in helping to calm or settle overactive bladders and bowels, and improve control and/or urge sensation in children who often don’t sense a need to void. Parents play a huge role in the implementation of these new daytime toileting habits and routines, especially in our very young clientele.
- Nighttime bladder training and routines. Some of the tactics first implemented in the fight against bedwetting are new habits leading up to bedtime and use of nighttime wetness alarms. “Dry bed training” can also be done in an attempt to identify what time of night wetting happens and slowly train the bladder away from wetting; the parameters of this program are set based on each child’s bladder and bowel diaries, as well as information gathered by the parents during the overnight hours. Parents also play a HUGE role in successful implementation of nighttime training and routines!!
- Helping your child build and maintain better bladder habits. Parents and children are asked to complete bladder and bowel diaries, usually prior to their first visit. These diaries allow us to at everything from fluid intake to volume of urination, frequency of urination, type of food eaten, regularity and consistency of bowel movements, etc. This information allows us make very specific recommendations about your child’s intake, voiding frequency/schedule, etc.
For additional information about some of the pediatric incontinence conditions that we treat, click here.
We recommend seeing your child's pediatrician for new problems or undiagnosed conditions, but we encourage you to CALL US WHEN YOU ARE READY TO GET YOUR CHILD'S THERAPY STARTED!