Why Add Pediatric Pelvic Floor Therapy to Your Treatment Arsenal?

Dawn Sandalcidi PT, RCMT, BCB-PMD is a trailblazer and leading expert in the field of pediatric pelvic floor disorders. She graduated from SUNY Upstate Medical Center in 1982 and is actively seeing patients in her clinic Physical Therapy Specialists, Centennial CO. Additionally, she runs an online teaching and mentoring platform for parents and professionals at www.kidsbowelbladder.com.

Dawn is a national and international speaker in the field, and she has gained so much from sharing experiences with her colleagues around the globe. In addition to lecturing internationally on pediatric bowel and bladder disorders, You can join Dawn Sandalcidi with H&W in her courses, Pediatrics Level 1 - Treatment of Bowel and Bladder Disorders and Pediatrics Level 2 - Advanced Pediatric Bowel and Bladder Disorders. This year H&W is excited to announce that Dawn will be teaching live for the first time since 2020, join her at the Pediatrics Level 1 course in Syracuse NY on June 3-4, 2023.

 

Why you should have these tools in your toolbox today.

As a clinician, it can be challenging to take a step back and look at every single patient as a whole person. Time constraints, hectic schedules, and never-ending notes make it difficult for you to do everything you’d like. Have you ever fantasized about an all-inclusive, multi-disciplinary center where physical therapists, occupational therapists, speech therapists, and other professionals gather weekly to assess a caseload of patients and make recommendations personalized to those patients?

Although clinics like this are not very common, you can bring a sense of this comprehensive approach to your clinic by expanding what you offer. As you know, many pediatric clinics offer PT, OT, Speech, and maybe aquatic therapy or early intervention services. Clinics offering pediatric pelvic floor therapy are more limited but on the rise.

You can bring these much needed services to your own clinic, and gain this knowledge without even leaving your home! If you’ve never considered expanding your services to include pelvic floor therapy for your pediatric patients, it’s time to explore exactly how this skill set can impact your patients’ lives.

Who Needs Pediatric Pelvic Floor Therapy?

Pediatric pelvic floor therapy is for children with bowel and bladder issues. Many of them also have special needs and will frequent your pediatric therapy centers. Since these patients in need will already be in your clinic, why not address as many of their issues as possible, all in one place?

Neurotypical children, as well as those with special needs (like children with cerebral palsy, spina bifida, sensory processing disorders, and other developmental or behavioral issues) often struggle with bowel and bladder conditions in addition to their chief complaints. These families may struggle on a daily basis to manage exercises, feeding, play, and oftentimes, toileting troubles as well.

You may be thinking that bowel and bladder issues are reserved only for children with more severe conditions, however many children with bowel and bladder issues do not have any underlying neurological conditions. Oftentimes, these bowel and bladder issues in children are due to pelvic floor dysfunction (PFD).

It’s not as easy for children to communicate when something is wrong, PFD can go undetected for long periods of time in this population. A study from 2019 found that 46% of constipated children and 67% of children with fecal incontinence rated bowel habits as good or very good. The authors also noted 50% of constipated children did not mention their symptoms to anyone.

Parents don’t always know what’s normal and even when they do figure out there’s an issue, they often don’t have a clue about where to start, or what pediatric pelvic floor therapy even is.

What is Pediatric Pelvic Floor Therapy?

Pediatric pelvic floor therapy is a specialty area with a focus on pelvic conditions and symptoms for children up to 18 years old. Pelvic conditions and symptoms will frequently affect both bowel and bladder function in children.

Pediatric pelvic floor therapy is one of several treatment methods under the umbrella of “Urotherapy”. Urotherapy is a non-standardized conservative based treatment option for children with voiding dysfunctions.2 Dysfunctional voiding (DV) refers to a group of abnormal lower urinary tract (LUT) symptoms such as straining, hesitancy, and dysuria. Other LUT symptoms involved are related to bladder storage, such as frequency, urgency, and incontinence.

Pediatric pelvic floor therapy is a great first-line treatment option for functional constipation. This refers to a vicious cycle of stool retention in the rectum which eventually leads to distention, loss of urge, and more constipation. Functional constipation is directly related to LUT symptoms and DV. It is estimated that up to 50% of children suffer from LUT symptoms with constipation at some point.

A majority of children with bowel and bladder dysfunction can be successfully treated with pediatric pelvic floor therapy. Your treatment plan may include education, lifestyle changes, bowel and bladder diaries, pelvic floor and trunk muscle retraining, sEMG, and more. In order to provide the best recommendations for families with children suffering from bowel and bladder dysfunction, it’s important to begin with a thorough initial evaluation.

What Does a Pediatric Pelvic Floor Therapy Evaluation Involve?

I would argue that almost every child could benefit from a pediatric pelvic floor therapy evaluation. Just like with pelvic floor therapy for adults, much of what you’ll do for pediatric pelvic floor patients is completely external. So many children will have significantly improved quality of life with basic behavioral changes.

Pediatric pelvic floor therapy evaluations involve first investigating the source of bowel and/or bladder dysfunction. Tools such as questionnaires and subjective assessments are integral to your assessment and provide measures for tracking success. Ultrasound is another tool commonly used to help gather information and make bowel and bladder dysfunction diagnoses in children.

This may seem obvious, but the orthopedic physical assessment you regularly perform as a pediatric therapist is another very useful tool used in determining sources of bowel and bladder dysfunction. You may be surprised to learn how frequently side-to-side discrepancies or overactive hip muscles play a role in bowel and bladder dysfunction. As with all diagnoses, determining the root of the problem will drive your treatment planning.

What Treatments Are Involved in Pediatric Pelvic Floor Therapy?

Pediatric pelvic floor therapy can be intimidating to therapists who have never treated PFD before. First, know that success can be achieved without any internal examination or treatment at all.

Pediatric pelvic floor therapy treatments may include bowel and bladder diaries, breath work, stretches, abdominal massage, behavioral modification, and exercises to achieve balance in trunk and lower extremity strength, length, and function. Parents are often encouraged to be involved in treatment techniques as they’re with their children a majority of the time.

Where Do Pediatric Patients with Pelvic Floor Dysfunction Currently Receive Care?

You may be wondering, “If pediatric bowel and bladder issues are so common, who is treating all these patients?” This is a great question, and the answer will likely disappoint you.

Since I started doing pediatric pelvic floor therapy over 30 years ago, I’ve met thousands of children from birth to 17 years old. I can’t count how many older children are referred to my clinic with issues they’ve had for as long as they can remember. PFD in children often goes untreated — this population is severely underserved.

Children suffer from embarrassment, isolation from peers, and decreased quality of life because of bowel and bladder dysfunction. Parents often don’t know where to go for help or what options exist, so the issues commonly persist into adulthood.

If a child is lucky enough to be referred to someone aware of pediatric pelvic floor therapy, this is the best first-line treatment. Oftentimes, however, parents and pediatricians alike are unaware of this option, and they never make it to our offices. Children may be treated by pediatricians with medication, or referred to specialists.

When is Medical Treatment Indicated over Pediatric Pelvic Floor Therapy?

It’s pretty mainstream to recommend physical or occupational therapy for children with fine or gross motor delays, but how often are pediatricians recommending therapy for bedwetting, incontinence, or constipation? Physicians are great gatekeepers and it’s your job as a therapist to partner with local pediatricians in your area so they know who you are and how you can help them, especially if you decide to add pediatric pelvic floor therapy as a service in your clinic.

Many children are unnecessarily referred to gastroenterology or urology for bowel and bladder issues that could be managed with pediatric pelvic floor therapy (and without the need for medication). I would argue that medications are often used more quickly than necessary, but that doesn’t mean they don’t have a place in the management of pediatric bowel and bladder dysfunction.

Laxatives are commonly recommended to treat constipation. There are also medications that can be prescribed for bedwetting and incontinence. Enemas are used for chronic constipation issues that either do not respond to initial treatment or are medically indicated for other reasons.

I almost always recommend trying dietary, behavioral, and physical interventions first. If a child is not responding well to these interventions after 30-60 days of treatment, medical intervention may be indicated. In my courses I go in depth about titrating medications and how you can assist families in finding the best overall treatment regimen for them in conjunction with their pediatrician.

How Can You Get Training for Pediatric Pelvic Floor Therapy?

You likely didn’t learn much of anything about pediatric pelvic floor therapy in school. Now that you know the basics about pediatric pelvic floor therapy and the dire need for more professionals trained in helping these patients, you’re likely wondering how you can dive in and help. 

I offer live and online courses to train healthcare professionals interested in treating pediatric bowel and bladder disorders. Why not offer your patients more than the standard, “hopefully you’ll grow out of it”? Your patients and their families deserve the best care available, and if I were a betting person, I’d bet on you!

Click below to learn more about my online and live course offerings for pediatric pelvic floor therapy. Hope to see you there!

This blog originally was posted on August 9, 2022, by Dawn Sandalcidi at https://kidsbowelbladder.com/why-add-pediatric-pelvic-floor-therapy-to-your-treatment-arsenal/.

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Pediatrics Level 1 - Bowel and Bladder Disorders - Syracuse, NY

Course Dates: June 3-4
Price: $625
Experience Level: Beginner
Contact Hours: 19.5

Description: This two day, in-person course includes pre-recorded learning followed by a live, in-person course taught by instructor Dawn Sandalicidi, PT. The pre-recorded learning must be viewed in Teachable before Day One of the course.

This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. The participant will learn terminology from the International Children's Continence Society, medical evaluation concepts for bowel and bladder dysfunction, and common dysfunctions in voiding and defecation. Common causes of incontinence in the pediatric patient will be covered, and a comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor and surface electromyography (or sEMG, a form of biofeedback).

Pediatrics Level 1 - Bowel and Bladder Disorders

Course Dates: August 26-27 and October 28-29
Price: $625
Experience Level: Beginner
Contact Hours: 19.5

Description: This two day, in-person course includes pre-recorded learning followed by a live, in-person course taught by instructor Dawn Sandalicidi, PT. The pre-recorded learning must be viewed in Teachable before Day One of the course.

This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. The participant will learn terminology from the International Children's Continence Society, medical evaluation concepts for bowel and bladder dysfunction, and common dysfunctions in voiding and defecation. Common causes of incontinence in the pediatric patient will be covered, and a comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor and surface electromyography (or sEMG, a form of biofeedback).

Pediatrics Level 2 - Advanced Pediatric Bowel and Bladder Disorders

Course Dates: May 20-21 and November 4-5
Price: $600
Experience Level: Intermediate
Contact Hours: 15

Description: This course will give you the confidence to treat any pediatric patient with bowel or bladder issues. Forget the days of a referral coming across your desk and thinking, “what in the world?”, then frantically searching the web for more information. This course gives you a lifetime of access to all things advanced pediatric pelvic floor, such as:

• In-depth rib cage assessment
• Next-level core evaluation and treatment techniques
• Updated DRA/pressure system exercise guidance
• Full-body movement analysis as it relates to the pelvic floor
• A deep dive into how specific disorders change a patient's movement and what to do about it