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Pee Problems in Pre-Teens and Teens

Pee Problems in Pre-Teens and Teens

Teen Incontinence

This is the second installment in our 3 part pediatric blog series written by Amanda Moe DPT, PRPC treats women, men, and children with disorders of the pelvis and pelvic girdleAmanda enjoys assistant teaching with the Herman & Wallace Pelvic Rehabilitation Institute in her free time as well as working out, practicing yoga, and spending time with her family. You can find Amanda online at www.pelvicphysicaltherapyandmore.com and on Instagram @amandampelvicpt.

Just as Mora from @PracticallyPerfectPT mentioned in the previous blog post, Big Issues for Tiny Humans, pelvic health specialists treat pelvic floor and pelvic girdles for all humans of all ages. This blog post aims to introduce why pre-teens and teenagers could need pelvic floor therapy for pee problems!

Pelvic girdle-related dysfunction in young children often manifests as bowel or bladder complaints such as constipation, poo leakage (fecal incontinence or encopresis), and day or nighttime pee leakage (incontinence or nocturnal enuresis). Young children can be potty-trained with NO pee or poo complaints for several years then suddenly develop these very same symptoms in the pre-teen or teenage years! Occasionally there is a cause for the change in pee or poo symptoms such as trauma, the birth of a sibling, moving to a new city, divorce, or other changes in family situation. However, oftentimes there isn’t a signifying event attributed to the onset of these symptoms—which is where assessment and treatment from a skilled Pelvic Physical Therapist (or Occupational Therapist) may be beneficial! 

Pediatric Pelvic Physical/Occupational Therapy

Pelvic Physical and Occupational Therapy in pre-teens and teenagers focuses on a whole-body assessment and treatment. Specifically, the Pediatric Pelvic Therapists will look at pelvic girdle influences on bowel and bladder complaints such as:

  • Pelvic muscle tension
  • Pelvic muscle strength
  • Pelvic muscle coordination
  • Abdomino-pelvic pressure management
  • Load transfer 
  • Breathing
  • Pelvic girdle strength
  • Core coordination and strength
  • Bladder and bowel habits
  • Food and fluid contributors

Common Urinary Complaints in Pre-Teens and Teenagers

Potty-training regression can occur and is commonly seen in Pediatric Pelvic Therapy. Below is a list of other pee problems commonly seen in pre-teens and teenagers (often addressed in Pelvic Therapy). 

  • Strong urge to pee (urinary urgency)
  • Frequent peeing
  • Chronic UTI’s
  • Urinary stream changes
  • Nighttime bedwetting (nocturnal enuresis)
  • Daytime leakage (urinary incontinence)
  • Leakage with activity or sport (stress urinary incontinence or SUI)

Urinary leakage during sport or physical activity (SUI) can commonly arise in the pre-teen and teenage years. A recent systematic review determined that SUI occurs in 18-80% or an average of 48.58% of adolescent female athletes (7). While stress incontinence is common in women after childbirth, it doesn’t have to be considered “normal” for women OR children. This is where Pediatric Pelvic Therapy comes into play to determine the factors (such as those listed above) that are impacting a child's leakage during sport or activity!

The Lower Urinary Tract (LUT) symptoms listed above and specifically daytime pee leakage are prevalent in 10–17% of children (2, 4, 8). Gastrointestinal (GI) dysfunction such as constipation is commonly associated with these LUT dysfunctions in pre-teens and teenagers. Research has shown constipation in 22-37.5% of children with LUTS (3, 5) with an additional study reporting that greater than 50% of children with LUT symptoms had some type of functional defecation disorder (1). This is why Pediatric Pelvic Therapists often address the GI system when pre-teens and teenagers present with pee problems!

To learn more about the GI systems in adolescents and how these symptoms influence pee problems in Pediatric Pelvic Therapy, check out Dawn Scandalcidi's interview on Friday! Herman & Wallace also offers two pediatric courses featuring assessment and treatment of urinary and bowel functioning:


Resources

  1. Burgers R, de Jong TP, Visser M, Di Lorenzo C, Dijkgraaf MG, Benninga MA. Functional defecation disorders in children with lower urinary tract symptoms. J Urol. 2013 May;189(5):1886-91. doi: 10.1016/j.juro.2012.10.064. Epub 2012 Oct 30. PMID: 23123369.
  2. Kajiwara M, Inoue K, Usui A, Kurihara M, Usui T. The micturition habits and prevalence of daytime urinary incontinence in Japanese primary school children. J Urol. 2004; 171(1):403–7. [PubMed: 14665943] 
  3. Loening-Baucke V. Prevalence rates for constipation and faecal and urinary incontinence. Arch Dis Child. 2007; 92(6):486–9. [PubMed: 16857698] 
  4. Malykhina AP, Brodie KE, Wilcox DT. Genitourinary and gastrointestinal co-morbidities in children: The role of neural circuits in regulation of visceral function. J Pediatr Urol. 2017;13(2):177-182. doi:10.1016/j.jpurol.2016.04.036
  5. Muhammad S, Nawaz G, Jamil I, Ur Rehman A, Hussain I, Akhter S. Constipation in Pediatric Patients with Lower Urinary Tract Symptoms. J Coll Physicians Surg Pak. 2015 Nov;25(11):815-8. PMID: 26577968.
  6. Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol. 2006; 176(1): 314–24. [PubMed: 16753432] 
  7. Rebullido TR, Gómez-Tomás C, Faigenbaum AD, Chulvi-Medrano I. The Prevalence of Urinary Incontinence among Adolescent Female Athletes: A Systematic Review. Journal of Functional Morphology and Kinesiology. 2021; 6(1):12. https://doi.org/10.3390/jfmk6010012
  8. Sureshkumar P, Jones M, Cumming R, Craig J. A population based study of 2,856 school-age children with urinary incontinence. J Urol. 2009; 181(2):808–15. discussion 815–806. [PubMed: 19110268] 

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A MUST-HAVE book for Pediatric Pelvic Physical Therapy

A MUST-HAVE book for Pediatric Pelvic Physical Therapy

Amanda Moe2

Amanda Moe, DPT, PRPC specifically treats women, men, and children with disorders of the pelvis and pelvic girdle. Amanda earned her Pelvic Rehabilitation Practitioner Certification (PRPC) in 2015 to distinguish herself as a highly qualified and specialized practitioner in the field of pelvic health and worked at Texas Children's Hospital in Houston, TX. There Amanda assisted with the development and expansion of the pediatric pelvic physical therapy program treating children with a variety of diagnoses such as bowel and bladder dysfunction, constipation, encopresis, coccydynia, abdominal/groin pain, as well as other disorders related to the pelvic girdle. Amanda enjoys assistant teaching with the Herman & Wallace Pelvic Rehabilitation Institute in her free time as well as working out, practicing yoga, and spending time with her family.

Before the Book

I started off my career in Pelvic Physical Therapy treating adult women and men as do many physical therapists entering the pelvic niche. My local children’s hospital discussed a need for pelvic physical therapy in children which, with the help of Herman and Wallace’s Adult/Pediatric courses as well as mentoring from my local Gastroenterology department, I devoted the next few years of my career to.  

I aided in program development and expansion of Pediatric Pelvic Physical Therapy services at Texas Children’s Hospital in Houston, Texas.  After moving out of state, I then collaborated and expanded Pediatric Pelvic Physical Therapy services in Pittsburgh, Pennsylvania—working closely with both the Urology and Gastroenterology Department at UPMC’s Children’s Hospital of Pittsburgh. While treating children with pelvic dysfunctions is similar to treating those in adults, there is much to be considered when providing education to children, parents, and even referring providers about pelvic floor dysfunction and Pediatric Pelvic Physical Therapy.

The NEED for this Book

When educating children, parents, or even referring practitioners about pelvic floor dysfunction and physical therapy, I grew frustrated with the lack of “simplified” or “child-friendly” models, illustrations, or depictions available. Specifically, I saw a need for:

  • the depiction of pelvic girdle muscles and organs in a “child-friendly” format for BOTH boys and girls
  • pictures of what a child’s pelvic muscle “role” or “activity” is during peeing or pooping
  • what common muscle dysfunctions in children “look like” in easy-to-understand pictures

Additionally, I longed for a book or resource that described common conditions and symptoms treated in Pediatric Pelvic Physical Therapy (or Occupational Therapy) as well as what the Pediatric Pelvic PT/OT evaluation and treatment may look like. In 2021, I decided to do something about this which lead to me writing my first book: Pelvic PT for ME: Storybook Explanation of Pelvic Physical Therapy for Children.

Amanda Moe1

Book Features

Do you have parents, patients, referring physicians, or other medical providers wondering exactly what Pelvic Physical Therapy for children is like—look no further! In Pelvic PT for ME: Storybook Explanation of Pelvic Physical Therapy for Children, I explain the basics all in a rhyming, child-friendly format. This book introduces the collaborative nature in resolving children’s potty or pelvic troubles and describes how Pediatric Pelvic PT/OT often works closely with gastroenterologists, urologists, pediatricians, or other providers to remedy a child’s complaints. Pelvic PT for ME has many unique features pertaining to Pediatric Pelvic Physical Therapy, some of which are highlighted below:

  • Common Conditions Treated
    • I discuss typical conditions that are treated in Pelvic PT such as pee leaks, poo problems (constipation, poo leaks/smears), nighttime bedwetting, pelvic pain, and many others.
  • Child-Friendly Anatomy Illustrations
    • Age-appropriate anatomical illustrations of muscles and organs in the pelvic girdle are utilized throughout the book to aid in explaining bowel, bladder, and pelvic functioning.
  • Pelvic Floor Muscles during Peeing or Pooping
    • Pelvic floor muscle anatomy, functioning, and dysfunction—as they relate to potty troubles—are discussed through the use of child-friendly images to enhance not only child but also parent and referring provider understanding.
  • Common Evaluation Techniques and Treatment Interventions
    • The Pediatric Pelvic Physical Therapy evaluation, as well as typical treatment interventions, are discussed and illustrated to make both children and parents excited to seek treatment!
  • Inclusion of Occupational Therapy
    • While the field of Pediatric Pelvic Physical Therapy in of itself is new, I briefly discuss the inclusion of Occupational Therapists also providing Pediatric Pelvic Therapy services.

Where to Purchase

My primary goal behind the creation of this book was to develop an affordable resource for every Pelvic PT/OT who treats children. Secondarily, my goal was to increase knowledge and understanding of our services to parents, children, and potential referral sources or colleagues. Pelvic PT for ME encourages parents and children to refuse the notion that potty troubles “go away with age” and empowers children to be active participants in their Pelvic PT (or OT) experience. Enjoy this comprehensive yet simple storybook explanation of Pediatric Pelvic Physical Therapy, available on Amazon for $15.

Contact

Contact me or check out my website for more information: www.pelvicphysicaltherapyandmore.com

IG/Facebook: amandampelvicpt

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