Patients with complex colorectal issues often struggle with constipation, difficulty emptying the bladder, and urine and stool accidents. There are a lot of medications and some surgeries that can help patients who deal with these issues. In addition to medical and surgical treatments, some patients can benefit from pelvic floor physical therapy.
The pelvic floor is a group of muscles that sits low in the pelvis that look and acts like a bowl that holds the structures responsible for pooping and peeing. When you are feeling the urge to use the bathroom, these muscles tighten up to hold in pee and poop until you can make it to the toilet. When you are on the toilet, these muscles will relax to allow you to completely empty your pee and poop.
Some patients who struggle with constipation, difficulty peeing, and accidents have trouble controlling their pelvic floor muscles. Some patients have pelvic floors that are too tight and don’t let out pee and poop as well as they should, and some patients have pelvic floor muscles that are too weak and can’t hold in pee and poop long enough to make it to the toilet. Pelvic floor physical therapy can help patients strengthen those muscles and relax them more easily.
The physical therapists who work with the pelvic floor have special training on those muscles. For children with issues going to the bathroom or who are having bathroom accidents, the pelvic floor physical therapist will look at the muscles in the abdomen, hips, legs, and the pelvic floor itself.
What to expect at your first visit with a pediatric pelvic floor physical therapist:
The therapist will ask questions about your child, including:
Medical history
Daily routine/Schedule
Toileting habits
Diet
Exercise
Current symptoms
Medicines and other treatments you have already tried
The therapist will assess your child’s strength, flexibility, balance, and posture.
The therapist may have your child sit on the toilet with clothes on to show the posture they use when toileting.
The therapist may look at your child’s pelvic floor muscles to see how well they can tighten and relax those muscles.
The therapist may use biofeedback, which is equipment with electrodes that stick to your child’s hips and bottom to allow the therapist, the child, and the parents to see how well they are squeezing and relaxing their pelvic floor muscles. This is not painful and does not involve anything done internally.
The therapist will then provide a plan for treatment that can include exercises to help improve your child’s strength, flexibility, stability, and posture.
After your initial visit with the therapist, you will be given a treatment plan that includes daily, at-home exercises as well as regular visits with the physical therapist. Doing the home exercises every day as instructed is the best way to improve the chances of the therapy working. Just like going to the gym, improvements happen slowly over time with regular and consistent practice.
Your physical therapist may also make recommendations about nutrition, water intake, and daily exercise in addition to the physical therapy exercises. The length of time your child will be seeing physical therapy is very individualized, however most patients need 8-12 weeks of consistent therapy and home exercises to see significant results.
Physical therapy can seem time consuming, however it is a great non-invasive treatment to help children with bowel and bladder issues achieve their goals and improve their quality of life.
Sarah Driesbach serves as an advance practitioner nurse at The Center for The Colorectal and Pelvic Reconstruction (CCPR) at Nationwide Children’s Hospital. Sarah utilizes her diverse background and experiences caring for patients with complex colorectal and urological conditions. Sarah joined the CCPR Team in 2017.
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