As previously mentioned in Part 1 & 2 of the Pelvic Rehabilitation: Visit #1” blog series, pain and other disorders of the pelvis can affect children as well as adults. When referred to physical therapy for pelvic rehabilitation oftentimes parents are surprised and confused as to what a physical therapist can do to assist in improving their child’s overall condition. The purpose of this blog post today is to give you—the parents–some general information on Pelvic Physical Therapy for the pediatric population as well as tell you what the first Pedi-Pelvic PT visit will be like.
What is Pedi-Pelvic Rehabilitation?
Pediatric pelvic rehabilitation uses unique physical therapy techniques to treat disorders involving the pelvis and pelvic floor muscles that may cause bladder and bowel voiding dysfunctions and pain. Common conditions that we treat include: urinary incontinence, incomplete bladder emptying, enuresis, fecal incontinence, constipation, encopresis, dyssynergic defecation, imperforate anus, Hirschsprung Disease, coccydynia, and abdominal/groin pain to name a few. Specifically, this type of physical therapy will look at the muscles of the pelvic girdle (including pelvic floor muscles) to determine if they are weak, tight, painful, or have the proper coordination associated with normal bowel and bladder functioning.
Treatment techniques may include pelvic floor relaxation and/or strengthening exercises, core muscle & breathing coordination exercises, manual techniques for trigger points or myofascial restrictions, behavioral training on toilet habits/hygiene/hydration, coordination training of the pelvic floor and pelvic girdle musculature, occasional use of modalities for pain control, and external biofeedback/e-stim. Pelvic floor PT with biofeedback can retrain the pelvic floor muscles to contract, relax, and bulge or “push” —techniques that are necessary to have normal bowel and bladder functioning with no accidents!
What to Expect During Your Child’s First Visit
First, you and your child will sit down with the Physical Therapist and talk about what brought you to Pelvic Physical Therapy. This is a great opportunity to tell “your child’s story” about their complaint or condition. The Physical Therapist will then ask questions about your child’s symptoms and medical history. Questioning will include detailed information on bowel and bladder functioning at current and in the past as these may affect the symptoms of the pelvic floor. The purpose of this questioning is to obtain as much pertinent information about your child’s condition so she is best able to determine the appropriate treatment approach and interventions to get your child better.
Next, the Physical Therapist will then examine your child’s sitting and standing posture, gross motor functioning, and how they walk. The way you hold your body and move may affect symptoms in the pelvic floor region. She will assess your child’s hips, low back, abdominals and pelvic girdle–paying special attention to alignment, range of motion, strength, and mechanics. Dysfunction at the hips, pelvis, low back, and abdominal region can contribute to pelvic floor and bowel/bladder dysfunction.
Next, depending on your child’s chief complaint, a pelvic floor evaluation may be indicated. This is typically done internally via the anus or vagina in adults however, is NOT typically performed internally on children.
What to Expect During a Pelvic Floor Evaluation
Due to embarrassment, pain, and anxiety often associated with bowel and bladder issues in children—it is the Physical Therapist’s goal to make the pelvic floor assessment as comfortable as possible for both you and your child. Remember the physical therapist does this for a living–seeing men, women, and children with pelvic-health related complaints daily. She strives to provide you and your child with a safe and comfortable environment to seek treatment for these sensitive issues.
The Physical Therapist requires parents or guardian to be present throughout the physical therapy sessions due to the sensitive nature of assessment and treatment. The assessment of pelvic floor will take place in a private room on a high-low mat–much like those that are used if you were getting a massage. The Physical Therapist will show you and your child a model of the pelvis and pelvic floor muscles and describe first how the external assessment will take place. She will then get your consent to proceed and give you an opportunity to ask questions before starting.
Next, the child will lie on their side and uncover their anal region so that they physical therapist may observe the coordination of the pelvic floor muscles. Remember—the pelvic floor muscles surround and support the openings (anus, vagina, etc.) thus dysfunction in these muscles can affect bowel and bladder functioning. The Physical Therapist will then observe the anus and perineal region when attempting to contract the pelvic floor (i.e. hold in pee), relax the pelvic floor, and bulge or “push” (as if passing gas or having a bowel movement). The therapist may have the child use a hand-held mirror or look at a pelvic model if they prefer to better comprehend the functioning of the pelvic floor muscles.
The Physical Therapist will explain the “pelvic clock” so that you and your child can have a reference of which area she will be assessing further (if needed) during the external examination. If necessary, the Physical Therapist will palpate externally for bony landmarks and pelvic floor muscles to feel for tightness as well as map out any areas of pain/discomfort. If indicated, the Physical Therapist may also grade the strength of the pelvic floor muscles based on visual observation and external palpation. If necessary, she may externally palpate and visually observe the perineum region while contracting the pelvic floor muscles, relaxing the muscles, and bulging or pushing out to assess your child’s coordination.
Lastly if indicated, animated external biofeedback may also be used to assess functioning of your child’s pelvic floor muscles. As mentioned previously, biofeedback is a treatment intervention that can assist in retraining the pelvic floor muscles to contract, relax, and bulge or “push” —techniques that are necessary to have normal bowel and bladder functioning with no accidents. Your child may then get dressed and use the restroom if desired.
When your child is ready, the physical therapist will discuss what she found through her assessment as well as how physical therapy may or may not help. You and your child will discuss your goals for physical therapy and the therapist will give you information on typical interventions used, length of sessions, as well as answer any questions you have. The Physical Therapist may then give you and your child “homework” for the first visit that will be tailored to the assessment findings, chief complaint, and learning style.
Allow me to reiterate that it is the Physical Therapist’s goal to make the pelvic floor assessment as comfortable as possible for both you and your child. You have the choice to proceed or terminate the assessment at any time, but at Restorations PT we strive to provide you and your child with a safe and comfortable environment to seek treatment for these sensitive issues. You are always free to ask your therapist if you have any questions before, during, or after your Pelvic Physical Therapy examination.