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How Pelvic Floor PT Helps Children with Constipation & Incontinence

In pediatric pelvic floor dysfunction, Pelvic Floor Dysfunction, pelvic floor physical therapy, Pelvic Health, Stress Urinary Incontinence by Shannon PacellaLeave a Comment

By Shannon Pacella, DPT, PHRC Lexington

Did You Know…

  • Bedwetting affects 15%-22% of children, and of those children, 10%-25% have urinary leakage during the day.1 
  • One of the primary causes of bedwetting and daytime wetting is constipation.1
  • 10%-25% of children who bed wet also have difficulty controlling their bowels.1
  • Awareness of bladder sensation and control of bladder begins between one and two years old. 
  • Voluntary control of pelvic floor muscles occurs by three years old. 
  • Typical urinary frequency in children is between four to seven times per day. 
  • Typical bowel movement frequency in children is between four to nine times per week. 


Pelvic Floor Dysfunction and Pediatrics:

  • Symptoms children may experience are:
    • Constipation
    • Urinary leakage, urinary urgency, urinary frequency
    • Voiding Symptoms: hesitancy, straining, weak stream
    • Bedwetting (Nocturnal Enuresis) 
    • Fecal leakage/incontinence
    • Pain: pain during urination/defecation, pain in genitals, bladder pain, urethral pain


  • Secondary factors for urinary dysfunction in children:1
    • Sleep disorders/impaired sleep pattern (sleep apnea)
    • Urinary tract/anatomical abnormalities
    • Life events (i.e. new baby, moving)
    • Diabetes


  • Diagnosing some of these dysfunctions may include:
    • Urodynamics and post void residual (PVR) to assess the child’s bladder capacity and how much urine is being left in the bladder after voiding.
    • Kidney Urinary Bladder (KUB) X-ray to assess for constipation.
    • Ultrasound to measure rectal distention which may be due to constipation.
    • Assessing for UTIs, kidney function, and diabetes. 
    • Bladder-Bowel Diary/Log:2
      • Voiding frequency/volume
      • Symptoms: urgency, hesitancy, leakage
      • Bedwetting 
      • Fluid intake: type of fluid, volume, time when drinking
      • Food intake: how much fiber in diet
      • Bed time and awake time
      • Bowel movements: straining, pain, abdominal pain/bloating
      • Fecal leakage


  • Effects of Bedwetting:
    • Poor self-esteem
    • Frustration, shame, guilt
    • Embarrassment for both child and parent/guardian


What is PFPT for Pediatrics and how can it help:

Musculoskeletal assessment:3

  • Posture
  • Lumbosacral spine 
  • Neurologic screening (testing reflexes/sensation)
  • Abdominal strength/coordination, assess for diastasis recti (yes, children can have this too, not just people who have been pregnant). 
  • Joint mobility/hypermobility screening
  • Breathing mechanics 


Pelvic floor physical therapy can helps kids to:

  • Learn what their pelvic floor muscles are and how to control them.
  • Find their bladder and teach them how to tell if their bladder is full in order to learn how to listen to their body to know when they have to go.
  • Teach proper voiding techniques and mechanics which includes how to sit correctly on the toilet and breathe effectively.
  • Teach exercises to help with bladder emptying and bowel movements.
    • Improve bladder capacity, bladder sensation, and bladder contractility.
    • Improve sensation for the need to have bowel movements.
  • Create a timed voiding plan to help reduce bedwetting and daytime leaks. 
  • Improve bowel habits to decrease constipation.


Pelvic floor physical therapy for the pediatric population can be very empowering by enabling children to learn how to be in control of their body’s bladder and bowel functions. We currently offer digital and in-person pediatric consultations. You may request a pediatric consultation with Molly Bachmann in San Francisco, CA, Melinda Fontaine in Walnut Creek, CA, or with Shannon Pacella at our Lexington, MA location. If you would like a digital consultation, you can call to schedule (510) 922-9836 or register on the website.

We also offer virtual consultations if you are not near one of our locations! For more information and to book an appointment please visit our website!


Further Reading:

Childhood Constipation and Bedwetting: The Pertinent Poop

Pediatric Success Story: Constipation interrupting your kids’ activities?



  1. Sandalcidi, D. Pediatric Pelvic Floor Rehabilitation: Enuresis. Medbridge. 
  2. Sandalcidi, D. Pediatric Pelvic Floor Rehabilitation: Testing and Tools. Medbridge.
  3. Sandalcidi, D. Pediatric Pelvic Floor Rehabilitation: Evaluation and Treatment of Common Conditions. Medbridge. 


Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

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