There are many differences between adults and children’s bodies. One difference you may not have thought of is their pelvic floor. As women we know how important our pelvic floor health is for continence after a baby. But in children there are some differences that effect its role in supporting their organs and toilet training your child. The Australian Physiotherapy Association was lucky enough to be able to speak to Dr. Carina Siracusa for a webinar masterclass on the paediatric pelvic floor. Dr Siracusa has her doctorate in physical therapy and has worked in the hospital system in Columbus Ohio. She was taught about pelvic health for the American Physical Therapy Association’s Academy of Pelvic Health Physical therapists since 2010. I would like to thank both the Australian Physiotherapy Association and Dr Siracusa for their time and knowledge surrounding the paediatric pelvic floor. This webinar was an introduction to the paediatric pelvic floor evaluation and treatment. This blog will be detailing the main points from her webinar for you all.
Dr. Siracusa reminds us that the main role of the pelvic floor in adults is to support the pelvic organs in standing. To state the obvious, babies are not standing up and their bodies often aren’t competing against gravity. Therefore, their pelvic floor is not required to work against gravity, so the muscles aren’t as developed as infants. As they begin to grow and start crawling and walking the pelvic floor muscles begin to develop to support the pelvic organs.
There are core stages of development that your child needs to move through to ensure their pelvic floor develops adequately. Dr. Siracusa states that crawling enables their spinal curvatures to develop while strengthening the abdominal muscles. Being in the position to crawl allows the child to learn how to coordinate their abdominal and pelvic floor muscles. This is important to ensure that they can use the bathroom effectively.
The second gross motor function is being able to stand upright unsupported. A child being able to stand unsupported enables them to develop the muscles necessary for postural control and activation of their pelvic floor. This upright stance is their pelvic floors first exposure to having to support their pelvic organs. Once your child begins to stand their pelvic floor begins to strengthen to support the pelvic contents. Being able to have postural control over their pelvic floor and abdominal muscles plays an important role in continence in your child. By the age of 13-14 your child should have full bladder capacity and postural control over their pelvic floor (Barozzi 2014). Children who have been diagnosed with Cerebral palsy, Down Syndrome or Autism are more likely to have difficulties with their pelvic floor strength, likely due to decreased postural control (Siracusa, C. 2020).
Dr. Siracusa states that infants will have a bladder capacity of 10ml to 60mls at 9 months old. This decreased capacity means that infants will void their bladder more regularly than adults. As the child gets older their nervous system matures. This maturation allows children to develop some control over the bowel and bladder. Dr. Siracusa outlines that by the age of 1 and a half – 2 years old a child’s bladder capacity has grown so they will not be emptying their bladder as frequently as they were as babies. By 2 years old they should be able to acknowledge the sensation of a filling bladder and be able to fully control their bowel and bladder. By 3 years old they are now able to store more in their bladder and can “hold on” longer, some leakage is considered normal in toddlers. There is no pin-point time for a child to reach complete dryness. Anywhere from 3-6 years old is considered acceptable for full day and night-time dryness. Children who have different levels of cognitive ability, motor function, sensory difficulties and neurological disorders may reach dryness at a later age. A typically developing child will generally become dry during the day before they do at night. Girls will often attain daytime continence prior to boys. Children shouldn’t experience any night-time leaking after about 4 years of age. However, this can vary from child to child and different circumstances.
For a child to be considered “incontinent” by a GP they must still be having either night-time or daytime wetting after the age of 5 as reported by Dr. Siracusa. This can either by immediately or after a period of dryness for at least 6 months. There are many different types of incontinence is children over the age of 5 with many different causes. Constipation or a distended bowel can often put pressure on the bladder or the nerve that supplies the bladder. This can lead to either an over or underactive bladder depending on the situation. Constipation can occur for due to anorectal malformations, poor sphincter control, past painful bowel movements or slow colon transit time. Children who have stool retention may be contracting their pelvic floor which also slows down the transit time for stool, leading to constipation.
Dr. Siracusa states that children who have been found to have dysfunction of the pelvic floor it is normally the discoordination of the muscles themselves rather than a strength issue. Physiotherapy has been shown to help in the evaluation and treatment of pelvic floor conditions in kids. At Bump Fitness we work with both the parents and children to educate and provide appropriate exercises to assist in whatever challenges they may be having. Education involves helping the family understand appropriate toilet positioning, dietary and fluid habits. While incorporating an exercise program that focuses on postural stability, balance, breathing and biofeedback techniques to help coordinate the pelvic floor muscles. If after reading this and you have further questions or would like a session to discuss any concerns you have, we’re happy to help in any way we can for your child.
Until next time!
- Siracusa, C 2020 Introduction to Paediatric Pelvic Floor Evaluation and Treatment (Webinar) https://cpd4physios.com.au/course/view.php?id=857