By Melinda Fontaine, DPT, PHRC Walnut Creek
- Many families struggle with constipation in children. Maya is a 10 year old who likes to swim, camp, and play with her little brother. She had suffered with constipation and fecal incontinence most of her life. A year ago, an x-ray showed that she had an enlarged colon from chronic constipation, and she had been using daily colonic enemas since then. The most recent imaging a few months ago showed the colon size had returned to normal. She tried taking fiber and senna without using enemas. Her stools without the enemas were large and hard. Her fecal leakage returned, so they increased the laxatives which made her vomit. She stopped the medicine and returned to daily enemas. With the enemas, her stools are soft and mushy. She has fecal incontinence when she has been backed up for days or is on a high dose of senna. She had anorectal manometry which diagnosed her with “pelvic floor dyssynergia type I.” I’ll explain what this means in a few paragraphs 😉
- Goals: Maya was limited in her activities because of her symptoms and the length of time it took her to have a bowel movement. She had a school camping trip coming up. She was going to need help from her mother for enemas there, but she would rather not. She wanted to have more sleepovers with her friends. She often had to leave friends’ houses or events to do her daily enema, and she really wanted to participate in these fun activities without interruption. Maya will be starting junior high next year and would like to have better control over her bowels by then to avoid awkward social situations and having to talk to her multiple teachers about it. Her doctor referred her to pelvic physical therapy.
- After having an enlarged colon for so long, Maya had difficulty identifying the sensation of having to evacuate her bowels. Then, she used daily enemas for a long time, which helped the colon size normalize, but did not allow her to practice recognizing the sensation of having a full bowel. The signals from her bowels to her brain telling her to go poop had not been present for years, and may feel unfamiliar when they return. She also had poor coordination of the pelvic floor muscles, which was preventing her from getting the poop out. “Pelvic floor dyssynergia type I” means that she could create a downward pressure starting from her abdomen to push the stool through her colon, but instead of the anus opening up to let the stool pass out, the anal sphincter squeezed shut and kept the stool inside.
- Maya would benefit from skilled PT to practice coordination of the muscles and improve relaxation and dropping of the muscles to improve her ability to pass stool without an enema. Improved muscle coordination and directing her attention to the sensations in her body would help her learn to recognize when her bowels are full. She noticed she felt gassy before and more energetic after a BM. I taught Maya what her pelvic floor does during a bowel movement and how she could see it move with a handheld mirror or feel it by sitting on her hands. At home, Maya was very diligent in her home exercise program. Every day, she practiced diaphragmatic breathing with a stuffie, yoga poses for pelvic floor relaxation, coordination exercises for the pelvic floor, and good bowel habits.
- With her and her family’s permission, I called Maya’s gastroenterologist who prescribed the daily enemas. I told them our plan for physical therapy and our goal for Maya to be able to pass her bowels without enemas. In order to practice pooping, she would need time to try pooping, but she did not often get the urge before her next enema. I asked if the doctor could create a plan for Maya to safely reduce the enemas to allow her time to practice pooping without an enema. The doctor agreed and called Maya and her family to discuss a new plan.
- Her new plan included a daily oral laxative and reducing the enemas to twice a week. She was relieved to find that she started having an urge to poop almost every afternoon when she stopped the enemas. She started having spontaneous bowel movements six out of the seven days of the week without straining, and her stools were shaped like beautiful smooth logs. Her fecal incontinence was once a week or less with this routine. She continued to practice her exercises to retrain her muscles, and her good bowel habits helped move stool through her intestines and create a recognizable sensation of having to poop. Maya and her family gradually spaced out the enemas until she was only using them when she had not pooped in a few days. Her persistence with the program from her doctor and the physical therapy exercises helped her body relearn how to have a bowel movement. Maya is very happy to be able to play at the neighbors house and not have to come home early to do an enema.
For more on pediatric pelvic floor dysfunction and constipation, check out these links:
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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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