We can help with these youth bowel and bladder issues:
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Home > What We Treat > Youth Bowel and Bladder Health
TAKE CONTROL OF YOUTH BOWEL AND BLADDER HEALTH
THERE IS AN EXPLANATION
Youth bowel and bladder issues are experienced by millions of children and adolescents across the US and the world.
Accidents are deeply distressing and embarrasing for kids, especially as they become tweens and teens.
Millions of children and adolescents around the world experience youth bowel and bladder dysfunction (BBD). BBD is the spectrum of lower urinary tract symptoms that may accompany bowel disturbance. Issues from BBD can range from childhood or teenage bedwetting to leaking urine when playing or sneezing: frequent urinary track infections; constipation; functional constipation when the child has daily bowel movements but still holds poop: and in some cases to have poop fall out their bottoms without knowing it.
The latest clinical insights in pediatrics recognizes youth bowel and bladder dysfunction as a functional disturbance of genitourinary motonervous system development [source]. Normal genitourinary muscle function should be evident by age 5. When this maturation of genitourinary development is delayed or disturbed, the sequencing of pelvic floor muscle or sphincter contractions in response to central nervous system signals becomes inadequate for the child or teen to have full control over bowel and/or bladder function [source]. Pediatric urologists recommend pelvic floor muscle training through biofeedback to help children with BBD [source]. Studies show therapy can resolve accidents in up to 80% of cases [source].
You’re In CONTROL! offers occupational therapy services to prevent pediatric accidents and provide answers to parents. We help kids Take CONTROL! of their bowel and bladder health in a safe and kid-friendly environment.
Citations:
1. Rakowska-Silska, M., Jobs, K., Paturej, A., & Kalicki, B. (2020). Voiding Disorders in Pediatrician’s Practice. Clinical Medicine Insights: Pediatrics, 14, 1179556520975035. DOI: 10.1177/1179556520975035
2. Fuentes, M., Magalhães, J., & Barroso, U., Jr (2019). Diagnosis and Management of Bladder Dysfunction in Neurologically Normal Children. Frontiers in Pediatrics, 7, 298. DOI: 10.3389/fped.2019.00298
3. Ladi-Seyedian, S. S., Sharifi-Rad, L., Nabavizadeh, B., & Kajbafzadeh, A. M. (2019). Traditional Biofeedback vs. Pelvic Floor Physical Therapy-Is One Clearly Superior?. Current Urology Reports, 20(7), 38. DOI: 10.1007/s11934-019-0901-9
4. Pekbay, Y., Ergin, O., Topuz, B., Sarikaya, S., Acar, Z. Z., Irkilata, H. C., & Dayanç, M. (2019). The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder. Neurourology and Urodynamics, 38(5), 1430–1442.
The statistics speak for themselves.
Tailbone (Coccyx) Pain
COCCYDYNIA: TAILBONE (COCCYX) PAIN
Tail bone pain, often referred to as coccyx dysfunction or coccydynia, is often a side effect of constipation or rectal distention. Chronic pressure from an overstretched rectum can injure the muscles and position of the tailbone.
The coccyx also provides support to important organs such as the rectum and anus. When coccyx pain is left untreated, it causes chronic low back and pelvic pain that is difficult to resolve with traditional physical therapy because the muscles are best accessed via the pelvic floor. A key symptom of coccyx dysfunction is pain and intolerance of sitting. There are many structures that attach onto the small surface area on the coccyx.
The position of the coccyx will affect everything that attaches to it, which is why women’s health therapists are uniquely qualified to treat coccydynia. In fact, medical research cites therapy to be 90% effective in treating coccydynia [source].
Therapeutic treatment modalities can include:
- Manual Techniques
- Joint Mobilization
- Pelvic Floor Muscle Training
- Biofeedback
- Transcutaneous Electrical Nerve Stimulation
- Cryotherapy/Thermotherapy
When coccyx pain is left untreated, it causes chronic low back and pelvic pain that is difficult to resolve with traditional physical therapy because the muscles are best accessed via the pelvic floor.
The goal for each patient with tailbone pain is to be pain free.
Citation:
Lirette, L. S., Chaiban, G., Tolba, R., & Eissa, H. (2014). “Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain.” The Ochsner Journal, 14(1), 84–87.
Bedwetting
BEDWETTING
You don’t have to wait for a child, tween, or teen to outgrow bedwetting.
Bedwetting, or nocturnal enuresis, is experienced by millions of children each year. Parents are often told their child will outgrow bedwetting, however nearly nearly 1,000,000 of U.S. teen and tweens have bedwetting accidents [source].
A survey of 21,000 parents found that if a child is still wetting the bed at age 9, they have a 70% chance of wetting the bed at age 19 [source].
Parents are often told their child’s bedwetting is caused by deep sleep, stress or laziness, behavioral issues, underdeveloped bladder, or an overproduction of urine. However, research doesn’t typically validate this. Research does show that children and adolescents who experience bowel and bladder voiding accidents have abnormal rectal distention with a rectal diameter of around 6–7cm wide, and delayed or disturbed pelvic floor muscle coordination [source]. An overstretched rectum impairs the coordination of the pelvic floor muscles. The childs urethral function is disturbed or delayed and cannot contract with enough power or speed to stay dry. When the rectum is overstretched, it also takes up the necessary space in the pelvis that the bladder needs to fill during sleep, so the urine leaks out onto the sheets or pullup.
A normal rectal diameter for children is 3cm and is measured by xray [source]. Pelvic floor muscle coordinaton time is measured with an EMG biofeedback machine by a pelvic floor therapist.
We always teach families and kids that accidents are not their fault.
Therapeutic exercises assist the child, tween, or teen in contracting and shrinking rectum size. So, when the bladder fills up, it has adequate space to hold urine. Therapeutic exercises also help children and teens develop the necessary pelvic floor muscle control so the urethra sensation is functional to hold urine inside the bladder when sleeping.
At our You’re In CONTROL! clinics, we do our best to make therapy a positive and life-changing experience because we understand medical intervention is often intimidating and even traumatic for children. We strive to make therapy fun using age-appropriate toys including poop emojis and water balloons to teach exercises. We also use kid-friendly books, models, and charts to educate kids and families about their dysfunction.
Pelvic floor therapy is proven to help children, tweens, and teens develop the muscle control they need to stop the bedwetting [source]. Children, tweens, teens, and parents are relieved to have a safe, knowledgable, and understanding place to rehabilitate bedwetting.
Therapeutic treatment modalities can include:
- Pelvic Floor Muscle Training
- Biofeedback
- Manual Therapy
- Therapeutic Activites
- Transcutaneous electrical nerve stimulation (TENS)
- Age-appropriate education
Our occupational therapy services empower and validate kids to take control of their body and feel like a normal kid again.
Citations:
1. Act for Youth. “Youth Statistics: Health.” Act for Youth. Act for Youth, January 1, 2023. https://actforyouth.net/adolescence/demographics/health.cfm.
2. Fuentes M, Magalhães J, Barroso U Jr. Diagnosis and Management of Bladder Dysfunction in Neurologically Normal Children. Frontiers in Pediatrics. 2019 Jul 25;7:298. DOI: 10.3389/fped.2019.00298. PMID: 31404146.
3. Yeung C.K, Sreedhar B, Sihoe JD, Sit FK, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU International. 2006; 97: 1069-1073. DOI: 10.1111/j.1464-410X.2006.06074.x
4. Hodges SJ, Anthony EY. Occult megarectum–a commonly unrecognized cause of enuresis. Urology. 2012 Feb;79(2):421-4. DOI: 10.1016/j.urology.2011.10.015. Epub 2011 Dec 14. PMID: 22173180.
5. Ladi-Seyedian SS, Sharifi-Rad L, Nabavizadeh B, Kajbafzadeh AM. Traditional Biofeedback vs. Pelvic Floor Physical Therapy-Is One Clearly Superior? Curr Urol Rep. 2019 May 30;20(7):38. DOI: 10.1007/s11934-019-0901-9. PMID: 31147796.
6. Pekbay Y, Ergin O, Topuz B, Sarikaya S, Acar ZZ, Irkilata HC, Dayanç M. The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder. Neurourology and Urodynamics. 2019 Jun;38(5):1430-1442. DOI: 10.1002/nau.24007. Epub 2019 Apr 20. PMID: 31006136.
7. Zivkovic V, Lazovic M, Vlajkovic M, Slavkovic A, Dimitrijevic L, Stankovic I, Vacic N. Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. European Journal of Physical and Rehabilitation Medicine. 2012 Sep;48(3):413-21. Epub 2012 Jun 5. PMID: 22669134.
Chronic Abdominal Pain
CHRONIC ABDOMINAL PAIN
It is especially important to see a physician prior to receiving therapy for abdominal pain to rule out other pathologies.
There are many causes of chronic abdominal pain, and patients often have gone through extensive medical testing without a definitive diagnosis determined. The gastrointestinal (GI) system has a profound influence on the body’s pain response via intricate connections with the nervous system in the fascial attachments. Abdominal pain can be produced when these fascial attachments do not move with the body.
Abdominal pain can also be produced by the enteric nervous system. The enteric nervous system (ENS) is large, complex, and uniquely able to orchestrate gastrointestinal behavior independently of the central nervous system (CNS). ENS dysfunction is often linked to digestive disorders and pain.
The brain receives a constant stream of interoceptive input from the GI tract, via the ENS, and integrates this information with other interoceptive information from the body with contextual information from the environment. It then sends an integrated response back to various target cells within the GI tract. In patients with functional abdominal pain syndromes, conscious perception of interoceptive information from the GI tract, or recall of interoceptive memories of such input, can occur in the form of constant or recurrent discomfort or pain.
Each patient with abdominal pain is different and requires an individualized evaluation and treatment plan. Treatment may include:
- Neuromuscular Reeducation
- Bowel Retraining
- EMG Biofeedback
- Compensatory Strategies
- Manual Therapy
- Electrical Stimulation
- Dietary Adaptive Techniques
While we require a PCP referral for all patients, it is especially important to see a physician prior to receiving therapy for abdominal pain, so they may rule out other pathologies.
Taking CONTROL! of abdominal pain is possible.
Accidental Bowel Leakage
ACCIDENTAL BOWEL LEAKAGE
Accidental bowel leakage, or encopresis, is an embarrassing issue that burdens up to 1–3% of kids [source].
Approximately 80% of children with encopresis are boys [source]. The social consequences of encopresis can be devastating.
There are several reasons children experience encopresis. Here is a breakdown of accidental bowel leakage issues we rehab:
1. Constipation or functional constipation that creates an overstretched rectum
A dry, hard mass of stool (impacted stool) blocks the rectum and the muscles of the anal sphincter are delayed or disturbed to hold fecal matter in. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool from farther up the digestive tract to move around the impacted stool and leak out. Removal of the mass is recommended to begin therapy.
2. Nerve Damage that inhibits the anal sphincter muscle from closing
Anal sphincter nerve damage can occur from excessive straining, obstruction, assault, or other neurological impairments.
4. Internal Hemorrhoids make it impossible to close the anal sphincter and bowel matter leaks.
5. Scarring from surgery or radiation decreases the elasticity of the anal sphincter or rectum, making it difficult to adequately hold in bowel matter.
6. Anal sphincter injury from childhood sexual abuse. In severe cases, this issue may require surgery.
Pelvic floor rehabilitation is up to 80% effective in the treatment of accidental bowel leakage [source].
Much of our success in rehab is using biofeedback EMG to reeducate kids on using their pelvic floor muscles in coordination with the anal sphincter. If you didn’t notice, there is an intricacy of neuromuscular structure involved that control the anal sphincter.
Treatment may include:
- Pelvic Floor Muscle Training
- Neuromuscular Reeducation
- Bladder Retraining
- Biofeedback
- Compensatory Strategies
- Scar Mobilization and Massage
- Electrical Stimulation
The social and relational burden of encopresis can be devastating to a kid’s development and self-esteem. At You’re In CONTROL! clinics we do our best to make therapy a positive and life-changing experience.
We always teach families and kids that accidents are not their fault.
Citations:
1. van der Wal, M F; Benninga, M A; Hirasing, R A. The Prevalence of Encopresis in a Multicultural Population. Journal of Pediatric Gastroenterology and Nutrition. 40(3):p 345-348, March 2005. | DOI: 10.1097/01.MPG.0000149964.77418.27
Bharucha, Adil E; Dunivan, Gena; Goode, Patricia; Lukacz, Emily; Markland, Alayne; Matthews, Catherine A; Mott, Louise; Rogers, Rebecca G; Zinsmeister, Alan R; Whitehead, William E; Rao, Satish; Hamilton, Frank A. Epidemiology, Pathophysiology, and Classification of Fecal Incontinence: State of the Science Summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Workshop. American Journal of Gastroenterology 110(1):p 127-136, January 2015. | DOI: 10.1038/ajg.2014.396
3. “Pelvic Rehabilitation Medicine Reviewed” By: Allyson Augusta Shrikhande, Medicine, B. P. R., & Shrikhande, R. B. A. A. (n.d.). Pelvic Floor Muscle Hypertonia. Pelvic Rehabilitation Medicine.
Violent Urge Leakage
VIOLENT URGE LEAKAGE
Violent urge leakage is a sudden urge that causes urine leakage.
This forceful urinary urge often hits with a common trigger such as arriving home, hearing water, or playing a video game.
There are other triggers such as walking past the kitchen sink, cold weather, making a decision when shopping, seeing your mom, the possibilities are endless.
Urinary urge leakage is an overresponse of the nervous system to the bladder.
In therapy, we use bladder retraining and other techniques to help regulate the neuromuscular input the bladder receives.
Treatment options used may include:
- Bladder Training
- Neuromuscular Reeducation
- EMG Biofeedback
- Pelvic Floor Muscle Training
- Age Appropriate Education
The goal in therapy is to identify triggers and normalize bladder impulses so a violent urge doesn’t saturate you.
At our You’re In CONTROL! clinics we do our best to make therapy a positive and life-changing experience because we understand medical intervention is often intimidating and even traumatic for children.
We always teach families and kids that accidents are not their fault.
Bladder Retention
BLADDER RETENTION
Bladder retention is the inability to fully empty the bladder.
Bladder retention can be caused a variety of medical issues including pelvic floor muscle spasms or tightness.
Therefore, the muscles of the pelvic floor are unable to hold a contraction long enough or with enough strength to fully empty the bladder.
Bladder retention can also be caused by an overstretched rectum that is delaying or distrubing the ability of the urethra to contract.
In therapy, we use bladder retraining and other techniques to restore neuromuscular function of the pelvic floor muscles, so the bladder can be fully emptied.
Treatment options used may include:
- Bladder Training
- Neuromuscular Reeducation
- Biofeedback
- Pelvic Floor Muscle Training
The goal in therapy is to fully empty the bladder so kids can cut down on their trips to the bathroom.
At You’re In CONTROL! clinics strive to make therapy fun, using age-appropriate toys and kid-friendly books, models, and charts. Education of kids and families is the key to successful treatment.
Bladder Leakage
BLADDER LEAKAGE
Stress incontinence is when bladder leakage is caused by coughing, sneezing, laughing, or exertion.
The incident of stress urinary incontinence in children is significant, with nearly 23% of school age kids experiencing accidents [source]. Increased amounts of intra-abdominal pressure become too stressful for the pelvic floor muscles and the result is accidental urine leakage.
Stress urinary incontinence is usually a result of increased urethral mobility and/or intrinsic sphincter dysfunction.
In therapy, we determine which structures are debilitated and provide an individualized treatment plan.
This can include:
- Pelvic Floor Muscle Training
- EMG Biofeedback
- Electrical Stimulation
- Age appropriate education
The goal in therapy is always to be 100% dry whether laughing, sitting, jumping (yes on a trampoline), or managing impact in any other sport.
At You’re In CONTROL! clinics, we do our best to make therapy a positive and life-changing experience using kid-friendly books, models, and charts to educate kids and their families about the physiological reasons for their issue.
We always teach families and kids that accidents are not their fault.
Citation:
Shrestha N, Sahukhala S, K C D, Sandalcidi D, Adhikari SP. Prevalence of Urinary Incontinence in School Going Children: A Cross-sectional Study. The Journal of the Nepal Health Research Council. 2021 Jan 21;18(4):676-680. DOI: 10.33314/jnhrc.v18i4.2506. PMID: 33510509.
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