(646) 355-8777
  • Home
    Home This is where you can find all the blog posts throughout the site.
  • Categories
    Categories Displays a list of categories from this blog.
  • Tags
    Tags Displays a list of tags that have been used in the blog.
  • Bloggers
    Bloggers Search for your favorite blogger from this site.
Blog posts tagged in Pediatric Incontinence

The day my son was born, my daughter had not defecated for 5 days, and her pain was getting pretty intense. My husband and his mom took her to Seattle Children’s Hospital for help, and they suggested using Miralax and sent them away. When they got back to my hospital room, my daughter was straining so hard it looked like she was about to give birth! Being physical therapists, my husband and I massaged her little muscles and told her to take deep breaths, and eventually she did the deed, yet not without a heart-breaking struggle. Little did I know then there is actually research to back up our emergency, instinctual technique.

Zivkovic et al (2012) performed a study regarding the use of diaphragmatic breathing exercises and retraining of the pelvic floor in children with dysfunctional voiding. They defined dysfunctional voiding as urinary incontinence, straining, weakened stream, feeling the bladder has not emptied, and increased EMG activity during the discharge of urine. Although this study focuses primarily on urinary issues, it also includes constipation in the treatment and outcomes. Forty-three patients between the ages of 5 and 13 with no neurological disorders were included in the study. The subjects underwent standard urotherapy (education on normal voiding habits, appropriate fluid intake, keeping a voiding chart, and posture while voiding) in addition to pelvic floor muscle retraining and diaphragmatic breathing exercises. The results showed 100% of patients were cured of their constipation, 83% were cured of urinary incontinence, and 66% were cured of nocturnal enuresis.

More recently, Farahmand et al (2015) researched the effect of pelvic floor muscle exercise for functional constipation in the pediatric population. Stool withholding and delayed colonic transit are most often the causes for children having difficulty with bowel movements. Behavioral modifications combined with laxatives still left 30% of children symptomatic. Forty children between the ages of 4 and 18 performed pelvic floor muscle exercise sessions at home, two times per day for 8 weeks. The children walked for 5 minutes in a semi-sitting (squatting) position while being supervised by parents. The patients increased the exercise duration 5 minutes per week for the first two weeks and stayed the same over the next six weeks. The results showed 90% of patients reported overall improvement of symptoms. Defecation frequency, fecal consistency and decrease in fecal diameter were all found to be significantly improved. Although not statistically significant, the number of patients with stool withholding, fecal impaction, fecal incontinence, and painful defecation decreased as well.

Therapists are increasingly learning about and treating pediatric patients who have pelvic floor dysfunction, yet there are still not enough of them to meet the demand. Many therapists I have spoken to are understandably concerned about how to transfer what they have done for adult patients to a younger population. Here are some of the more common concerns therapists express or questions they ask in relation to the pediatric population:

  • Can we use biofeedback with children?
  • Do we complete internal assessments on kids?
  • How do we change the way we talk to the children?
  • How much do we have to teach the parents to get the information across?
  • Why do we teach strengthening even if some of the kids mostly need relaxation or coordination?

Although each question deserves a longer answer, we can start with biofeedback, and the answer is a resounding “yes”. There is abundant research affirming the potential benefit of biofeedback training for children with pelvic floor dysfunction. And no, we do not typically complete an internal pelvic muscle assessment on children, as that would not be appropriate. Considering that pediatrics can refer to young adults up to age 18-21, there may be a reasonable clinical goal in mind for utilizing internal assessment or treatment. The words we use when we speak to children become very important. Herman & Wallace faculty member Dawn Sandalcidi (known as “Miss Dawn” to her younger patients) gives ample strategies for adapting our language in her continuing education course Pediatric Incontinence and Pelvic Floor Dysfunction. For example, Dawn emphasizes the importance of describing an episode of incontinence as a “bladder leak” and of pointing out to a child that his or her bladder leaked, rather than the child leaking. She also likes to encourage parents and school personnel to drop the term “accident” from vocabulary. In her 2-day course, Dawn also teaches therapists how to train children to become a “Bladder Boss”, and how to teach young patients about relevant anatomy.

The Pelvic Rehab Report had an opportunity to interview Dawn Sandalcidi, the creator and instructor of "Pediatric Incontinence and Pelvic Floor Dysfunction". Dawn has developed a pediatric dysfunctional voiding treatment program in which she lectures on nationally. Dawn has published articles in the Journal of Urologic Nursing, the Journal of Manual and Manipulative Therapy, and the Journal of Women’s Health Physical Therapy. Let's hear more from Dawn about her Pediatric Incontinence and Pelvic Floor Dysfunction course!

What essential skill does your course add to a practitioner’s toolkit?

Recent research in The Journal of Pediatric and Adolescent Gynecology points to the alarming number of young women who present with pelvic pain who in fact also have endometriosis. Dr. Opoku-Anane and Dr. Laufer report that prevalence rates of endometriosis in an adolescent gynecology population have likely been underestimated (reported range of 25-47%) and that with advanced surgical methods the rates have been estimated to be as high as 73% in those who have pelvic pain. In their retrospective study, 117 subjects ages 12-21 completed laparoscopic examination for endometriosis. These subjects did not previously respond to non-steroidal anti-inflammatories or to oral contraceptives, and they were all referred for evaluation of chronic pelvic pain. In addition to collecting data about patient symptoms, the stage and descriptions of any endometrial lesions were documented.

A remarkable 115 of the 117 subjects (98%) presented with Stage I or II endometriosis as defined by the American Society for Reproductive Medicine guidelines. (Click here for the link to a detailed patient education document from the ASRM that describes endometriosis as well as staging.) The median age for onset of menarche in this population was 12 years old, and the median age of first symptoms reported occurred at age 13. Nearly 16% of the subjects also reported gastrointestinal complaints, menstrual irregularity in nearly 8%, and 76% of the participants reported a family history that included endometriosis, severe dysmenorrhea, and/or infertility. The authors of this research point out that advances made in surgical technique, both from a technological standpoint and a physician skill level, may be contributing factors in the increased rates of diagnosis of endometriosis.The authors also point out that it is yet unknown if early diagnosis and treatment will lead to improved outcomes in this population.

If you are interested in learning more about endometriosis in general, click here to follow the link to a free, full text article in PubMed Central. The article was first published in 2008, and even though advances in surgical diagnosis have been made, most of the information related to symptoms, medical treatment, and related risks remain significantly unchanged. In relation to etiology of endometriosis, one study that has set forth an environmental risk for endometriosis can be accessed here. Dr. C. Matthew Peterson, one of the researchers involved with the ENDO study, presented at the 2011 International Pelvic Pain Society meeting, and he encouraged all present to consider implementing strategies to minimize risks from chemicals in our daily lives. The Environmental Protection Agency offers advice towards protecting our health that can be accessed here. If environmental hazards are influencing the onset or progression of conditions such as endometriosis, it is in our best interest to reduce these risks. Consider not only the product exposure at home, but also at the workplace, and request less toxic products including cleaners when able.

Upcoming Continuing Education Courses

Feb 26, 2016 - Feb 28, 2016
Location: Evergreen Hospital Medical Center

Mar 4, 2016 - Mar 6, 2016
Location: Comprehensive Therapy Services

Mar 5, 2016 - Mar 6, 2016
Location: St. Luke’s Hospital Rehab Services

Mar 6, 2016 - Mar 8, 2016
Location: Touro College: Bayshore

Mar 11, 2016 - Mar 13, 2016
Location: Cottage Rehabilitation Hospital

Mar 12, 2016 - Mar 13, 2016
Location: Pacific Medical Center

Mar 12, 2016 - Mar 13, 2016
Location: Texas Children’s Hospital

Mar 18, 2016 - Mar 20, 2016
Location: The George Washington University

Mar 19, 2016 - Mar 20, 2016
Location: One on One Physical Therapy

Mar 19, 2016 - Mar 20, 2016
Location: Mercy Hospital

Apr 1, 2016 - Apr 3, 2016
Location: Marathon Physical Therapy

Apr 1, 2016 - Apr 3, 2016
Location: Mercy Hospital

Apr 2, 2016 - Apr 3, 2016
Location: Anne Arundel Medical Center

Apr 2, 2016 - Apr 3, 2016
Location: Florida Hospital - Wesley Chapel

Apr 8, 2016 - Apr 10, 2016
Location: CentraState Medical Center

Apr 8, 2016 - Apr 10, 2016
Location: Meriter Hospital

Apr 15, 2016 - Apr 17, 2016
Location: Loyola University Stritch School of Medicine

Apr 16, 2016 - Apr 17, 2016
Location: Doctors Hospital Pelvic Health Institute

Apr 16, 2016 - Apr 17, 2016
Location: Kima - Center for Physiotherapy & Wellness

Apr 22, 2016 - Apr 24, 2016
Location: Providence St. Josephs Medical Center

Apr 23, 2016 - Apr 24, 2016
Location: The George Washington University

Apr 23, 2016 - Apr 24, 2016
Location: Mizzou Physical Therapy-Rangeline

Apr 29, 2016 - May 1, 2016
Location: Duke University Medical Center

Apr 30, 2016 - May 1, 2016
Location: Sports Medicine Institute

May 1, 2016 - May 3, 2016
Location: Southview Hospital

May 1, 2016 - May 2, 2016
Location: Southview Hospital

May 13, 2016 - May 15, 2016
Location: Isanti Physical Therapy

May 14, 2016 - May 15, 2016
Location: Inova Alexandria Hospital

May 21, 2016 - May 22, 2016
Location: Seton Healthcare Center

May 21, 2016 - May 22, 2016
Location: Unity at Ridgeway Physical Therapy