Pelvic Floor Therapy for Constipation: How Working With a Pelvic Floor Specialist Can Help Relieve Constipation in Kids

One often overlooked, and rarely discussed component that could be the missing piece in resolving your child’s constipation is the pelvic floor. While we hear a lot about pelvic floor therapy for women, it isn’t as openly discussed for children. And, it definitely needs to be.

First, we want to get something out of the way. Unlike treating adults, pelvic floor therapy in kids does not involve any internal examination. So rest assured, most everything is external.

This is a big concern for many parents and it often stops them from learning more about how pelvic floor therapy can help their child with constipation.

Now that we’ve got that out of the way, let’s dig into the details of how the pelvic floor plays a role in constipation.

Treating any pelvic floor dysfunction, in combination with nutrition help, is a game-changer with the children we work with at the clinic. In our clinic we’ve seen countless positive outcomes when using pelvic floor therapy to treat children with constipation.

What Is the Pelvic Floor?

The pelvic floor is the group of muscles that connects the pubic bone at the front of the pelvis, to the coccyx at the base of the tailbone. Its role is to:

Support the organs in the lower part of the body
Keep everything in place when there is an increase in abdominal pressure (like when you cough or sneeze)
Control the sphincters (openings surrounded by muscle) where the pee and poop come out

Next, let’s talk about how the pelvic floor affects constipation in kids.

What role does the pelvic floor play in constipation in kids?

The anal sphincter controls pooping and is controlled by the pelvic floor. Therefore, if the pelvic floor isn’t working properly, your child may not be able to poop properly.

Unlike a lot of muscles that are normally relaxed, the pelvic floor remains somewhat contracted, or tense until it is time to poop. Your child should then relax the anal sphincter so that the poop can move out of their body more easily.

Learning to relax the anal sphincter is part of potty training. And, it's pretty common for this learning to get mixed up resulting in poop and pee issues like withholding, encopresis, and daytime wetting. By the way, this isn’t your fault. This seemingly “simple” process is actually quite complex. And, a lot more parents and children struggle with potty training more frequently than you think. People just don’t talk about it.

If the pelvic floor muscles are too tight, or your child doesn’t know how to properly relax them, withholding may occur. There are also mental reasons your child may choose to withhold that we won’t be addressing in this article.

On the other hand, if the pelvic floor is too weak and stretched or the child is unable to sense when the rectum is full, your child may have poop accidents (encopresis) or leaking.

Or, both of these situations can happen. This is when your child sometimes has accidents and other times is withholding. It can be so confusing and frustrating!

How does a pelvic floor specialist work with kids?

Pelvic floor therapists focus on helping your child retrain their pelvic floor muscles in order to relieve their constipation.

When working with children, the pelvic floor specialist will talk with you and your child about what they’re experiencing and their goals for therapy. Then the therapist will work with you to develop a treatment plan that works best for your child.

Some tools that can be used include:

Breathing exercises
Core activation exercises
Learning proper “potty posture”
Explaining how to poop
Describing techniques to properly poop
Learning exercises to contract and relax the pelvic floor

Your child’s treatment plan may include some or all of these tools. There is one more tool that we use with a lot of success - biofeedback therapy.

What about pelvic floor biofeedback therapy for constipation in kids?

Biofeedback therapy used for constipation in kids has proven to be extremely helpful in treating constipation. Biofeedback is used to help children learn how to coordinate their pelvic floor muscles. This includes teaching them to contract and relax the anal sphincter.

While contracting and relaxing the anal sphincter seems simple, a lot of the children we work with don’t really understand how it works. They’ll contract when they think they are relaxing and vice versa. That’s where biofeedback comes in and provides the missing piece of the constipation puzzle.

In using biofeedback therapy, the child retrains his/her pelvic floor muscles to contract and relax, when appropriate – these are basic mechanics that are needed for normal bowel and bladder function.

As a side note, biofeedback therapy can also help children who struggle with:

Bedwetting
Pee accidents
Painful bowel movements
Can’t feel the urge to have a bowel movement
Can’t push enough to get the bowel movement out

What happens during pelvic floor therapy sessions?

Having this first session can be nerve-wracking. And, we don’t want it to be! All appointments are one-on-one so you and your child have complete privacy with Annette, one of our pediatric physical therapists.

We’ll start by introducing ourselves to one another and then jump into hearing about your child’s toileting struggles. She wants to hear about you and your child’s concerns. She’ll also take a full history to be sure she’s aware of any other things that may be affecting your child’s bowel and bladder functions.

Annette will then perform a physical exam on your child to assess the strength and function of their core and other relevant areas. This is ALL EXTERNAL. If necessary, an external exam of the pelvic floor muscles will be performed to assess their function. This exam is non-invasive and will be performed with you in the room.

Finally, Annette will work with you and your child to develop an individualized treatment plan. The treatment plan will be modified and advanced as your child shows progress.

In biofeedback therapy, electrodes are placed externally around the genitalia to assess the child’s ability to contract and relax their pelvic floor muscles. For everyone’s comfort, the parent usually places the electrodes on the child with guidance from the therapist.

Once the biofeedback therapy begins, you and your child are able to look at a monitor and see what’s going on. This gives your child real-time feedback about what they think they are doing and what their muscles are actually doing.

After the first session, additional sessions usually last 45-minutes to one hour. On average, children initially need to meet weekly for 4 to 8 weeks. The number of sessions needed depends on the issue and how fast they progress.

What other things need to be addressed to help relieve constipation in kids?

Nutrition and hydration are the other main pieces of the constipation puzzle. That’s why Annette, our pelvic floor specialist, and Jessica, our dietitian, work as a team with our clients.

Often, what we think is enough fluids and fiber for our children isn’t enough. And, we often find that other interventions, tools, tips, and tricks are needed – like using coconut oil to help relieve constipation.

Help your child find constipation relief

Dealing with constipation in your child can be scary because no one really talks about it. We’re here to partner with you and your child. Together, we’ll put all the pieces of the constipation puzzle together, so you can both find relief.

We’ll work together to:

Normalize bladder and bowel habits
Decrease the number of urinary/fecal accidents
Help reduce the number of medications being used to manage your child’s bowel and bladder function

Reach out to the Constipation Gurus by completing our contact form to see if pelvic floor therapy for constipation is the next right step for your child.

Pelvic Floor Therapy for Constipation Relief in Kids