Dysfunctional Elimination in children occurs when the pelvic floor muscles (PFM) are not working together with the bladder and/or bowel, and the normal voiding or emptying reflexes can be disrupted. This can lead to a chronic abnormal pattern of elimination which does not allow the bladder or bowel to empty completely. Some children experience difficulty urinating or controlling their bladder function, frequent bladder infections, constipation, not urinating enough during the day, or sensing bladder fullness. Children may periodically have leakage during the day or wake up wet in the morning or both. This can be embarrassing and uncomfortable. If your child has experienced any of the above symptoms, they may have been seen by a physician or specialist, who is now recommending therapy to relax and retrain the pelvic floor muscles.
How can therapy help your child?
Some children do not completely empty their bladders and there is residual urine left in the bladder. This is called a PVR or Post Void Residual. One reason this can happen is if the pelvic floor muscles are not relaxed throughout the entire void. A Rehabilitative Ultrasound (RTUS) is used to look at the bladder and see if it has emptied completely. We call these "jelly belly's" and it is completely non-invasive. A sound head is placed over the lower abdomen and takes ultrasound pictures of the bladder to measure the volume inside. This tool helps assess progress to ensure the bladder is emptying completely as therapy progresses.
Therapy can provide the tools your family needs to take control of your child's bladder and bowel functions. Optimally, the bladder and pelvic floor muscles work opposite each other to successfully urinate. When the bladder muscle contracts or the bowels need to empty, the pelvic floor muscles relax. Your child will learn exercises to relax and strengthen the pelvic floor muscles at the appropriate time, void and empty completely, as well as to avoid urinary and/or bowel leakage.
Animated surface biofeedback may also be used to teach your child how to relax the pelvic floor muscles while emptying his/her bowel or bladder and strengthen the muscles in between voids. A specific home program will be developed for your child. Using the tools of education and exercise about the basic mechanisms that control the bladder and bowel, your child will be taught the correct way to utilize the pelvic floor muscles, which allows your child to control elimination. Therapy continues with your child learning correct postures for toileting, foods that may be irritating to the bladder and how to create a regular pattern of filling and emptying the bladder through a toileting schedule. Therapy can help your child achieve dry days and nights.
What should we expect when we go to therapy?
Expect help! Once you have scheduled your first appointment with us, we will need to gather important information to ensure we provide you with the best possible care. A patient information packet will need to be completed and provided to our staff when you arrive for your first appointment. The patient information packet will include a description of what to expect, as well as a patient history questionnaire. Your patient information packet can be mailed to your home or downloaded here. Also, you will be asked to complete a bladder diary with your child for at least 3 days prior to the first appointment. This entails documenting amounts and type of food and fluids your child drinks and well as voiding patterns. This is very important information to have completed before your first visit. For more information please visit Frequently Asked Questions page.
After a thorough evaluation has been performed, you and your therapist will develop a treatment program. This program will include:
- pelvic floor muscle visual evaluation and treatment
- a bladder schedule to improve bladder habits, education on bladder function and its relationship to the pelvic floor muscles
- biofeedback of the pelvic floor muscles to relearn how to strengthen and improve muscle function
- home exercise program
Children usually need to be seen 1 hour the first visit and then every other week for 1 full hour. Patients are seen an average of 6-8 visits. At the first visit we will discuss with you and your child the previously completed questionnaires, the bladder log and the medical history. We will discuss the condition directly with your child while a parent or guardian is present. A treatment program is begun the first visit including child/family education.
Dawn was highlighted in an article in PT in Motion. Click here to read further about her extensive work with children and incontinence.