Pediatric Bedwetting, Constipation, and Physical Therapy

Did you know that up to 80% of children with enuresis (bedwetting) have some level of constipation? Bedwetting in children can result in sleepless nights, missed sleepovers, and frustration for the entire family. Constipation can be painful, scary, and messy. As the mom of a constipated kiddo, I understand how overwhelming it can be to juggle all of the different aspects of your child’s bowel and bladder. It is always a good idea to check in with your pediatrician or pediatric GI doctor concerning constipation and day/night leakage, but let’s talk about a few ways that physical therapy can also help!

The Bedwetting and Constipation Connection

Constipation has a significant effect on the urinary system and pelvic floor muscles. This can contribute to daytime and nighttime episodes of urinary leakage. Stool physically takes up space in the abdomen and can give the bladder incorrect signals of fullness. Stool can add weight to the abdomen and pelvis that the pelvic floor muscles must support throughout the day. This can contribute to increased muscle tension, tightness, and weakness. Stool retention can also increase the risk of urinary tract infections. If the bowels are not emptied on a regular basis, bacteria can build up and access the urinary system. Proper wiping techniques and staying regular helps to decrease this risk.

Pediatric Pelvic Floor Physical Therapy

Pediatric pelvic floor physical therapy can be a great resource for managing all of this. During a physical therapy evaluation, we first take a look at how the pelvic floor muscles are functioning using surface electromyography, or SEMG. Pediatric pelvic floor physical therapy is very different from how we approach adult pelvic floor physical therapy. First, we do only external evaluation of the muscles and tissues, mostly by visual exam and use of the SEMG placed at the anus. From there, we can see if the pelvic floor muscles are contracting and relaxing when they should be. Often times there can be a disconnect in how these muscles are working, which can then affect your child’s ability to pee and poop. We also assess posture, gait, pelvic alignment, and muscle strength of the hips and core. This provides a lot of useful information that can help us form an individualized treatment plan for your child.

In addition to improving strength and coordination of the pelvic floor muscles, one of our other goals in physical therapy is to help promote movement through the gastrointestinal system. This includes education on proper hydration and fiber intake, massage and breathing techniques, toilet positioning, and proper wiping techniques. We also utilize a bowel and bladder diary to help create a schedule and plan that works for your family.

Causes of Constipation

There are many factors that contribute to constipation in children; fear of the toilet or a change in school routine can affect a child’s ability to have a bowel movement. There may also be a sensation of incomplete emptying of stool. This occurs in about 12% of children. These are all important things that to take into consideration when evaluating a child for physical therapy.

Pediatric Pelvic Floor Physical Therapy at Sage Physical Therapy

It is always a good idea to consult your pediatrician if you are concerned about your child’s bowel or bladder function. Pediatric pelvic floor physical therapy can be a great adjunct in the management of constipation and day/night leakage. At Sage Physical Therapy, we will work closely with you and your child to create a treatment plan that will help meet your family’s goals. Feel free to contact us at Sage Physical Therapy if you have any questions about constipation, bedwetting, or pediatric pelvic floor physical therapy!

Written by Kerry DeGaetani, PT, DPT, SCS. Kerry is an adult and pediatric pelvic floor physical therapist and the proud mama of two spirited kiddos. Information adapted from Pediatric Incontinence and Pelvic Floor Dysfunction, Herman and Wallace coursework.