Potty Training? Here’s What You Need to Know About Pelvic Floor Function in Kids

  • Copy By: Mary Noreen Cheng, PT, DPT
  • Feature Image By: Baby Björn

A lot of us have probably heard about pelvic floor physical therapy for women postpartum, but did you know that pelvic floor physical therapy also exists for children?

While the situations may differ, the underlying concept is relatively the same: pelvic floor dysfunction. Pelvic floor dysfunction is when the pelvic floor muscles develop an inefficient ability to contract or relax, thus contributing to a variety of symptoms. Pelvic floor dysfunction can contribute to frequent accidents, frequent voiding (think urinating or pooping), painful voiding, or more medical issues, such as frequent urinary tract infections or chronic constipation.

So, how does this happen and how can we avoid it for our children?

Pelvic floor dysfunction is relatively common (and very infrequently discussed) and can develop in children due to a variety of different factors. Very commonly, pelvic floor dysfunction develops when a child learns poor potty-training habits. When a child learns to potty train, he or she should learn to properly relax the pelvic floor in order to void, what voiding on a regular schedule looks like, and lastly, should be positively enforced throughout the process.

When these things don’t happen, children could learn to hold for long periods of time, use poor mechanics in order to void, or may hide accidents from caregivers. And when these behaviors develop, pelvic floor dysfunction may rear its ugly head with symptoms such as painful voiding, frequent accidents, or infections. Less commonly, some medical diagnoses and a history of sexual abuse can also contribute to pelvic floor dysfunction. 

The following are five tips to promote healthy voiding habits and avoid pelvic floor dysfunction (for you and your child!): 

 

Source: @oxotot

 

1. Maintain positive emotions surrounding potty training

Try to avoid shame or guilt when potty training. If your child is having difficulty potty training, chances are, he or she is not quite ready yet. When your child is able to verbalize that he or she needs to use the restroom, this is a good time to start thinking about potty training.

When your child is ready, encourage frequent voiding and encourage a full void, meaning try to make sure they completely empty. You can promote fully emptying by avoiding distraction (avoid iPads, books, toys on the toilet), encouraging deep belly breathing to fully relax the pelvic floor, and encouraging your child to wait a couple more seconds after he or she feels like the bladder is empty (which, let’s be honest, isn’t very easy for a moving toddler, but try what you can!).

When your child does successfully use the toilet, use plenty of positive feedback. And try to avoid giving negative feedback when your child has an accident – accidents happen, and that’s OK.

 

2. Maintain a regular voiding schedule

Even after potty training is over, it’s important to encourage your child to void regularly. When we wait too long to void, our bladder can become distended, and our body can become immune to the bodily signals that tell us that we need to use the bathroom.

Try to encourage your child to void at least every two hours (and, of course, whenever you see the potty dance!). This will ensure that your bladder stays a healthy size, bacteria doesn’t sit too long in your bladder, and your pelvic floor doesn’t become stressed by holding for too long.

When your child is having difficulty remembering to use the bathroom, you can set alarms on your phone, you can try an alarm on a watch, or use natural breaks in the day to remind your child to use the bathroom (before meals, naps, leaving the house, etc.). 

 

When your child does successfully use the toilet, use plenty of positive feedback. And try to avoid giving negative feedback when your child has an accident – accidents happen, and that’s OK.

 

3. Maintain adequate water intake

When you encourage using the bathroom every two hours, there obviously has to be something to void. So, make sure your child is adequately hydrated. Again, I know encouraging a moving toddler or child to slow down isn’t easy, so try to sneak it in as much as you can. Mix water with (a very small amount of) juice or try fun cups and water bottles to encourage more water intake if your child is resistant. Adequate water intake also helps to avoid constipation, which is very important.

 

Source: Baby Björn

 

4. Avoid constipation

The bowel and bladder live right next door to each other. When you have a full bowel pushing up against the bladder, the bladder can become irritated, leading to frequent and incomplete voiding. When we don’t fully void, the bacteria in the bladder can lead to frequent urinary tract infections. So, it’s important to stay regular.

Drink enough water, eat enough fiber, and stay active so that constipation doesn’t become a factor. Pooping should never be painful. When pooping becomes painful, a child is more likely to hold, leading to more constipation, and the cycle continues. 

 

5. Use proper posture

There’s a proper posture for everything else in life, so why wouldn’t there be a proper posture for voiding?! Most toilets aren’t made for little ones who are learning to use the bathroom for the first time because the feet should always be supported. When our feet are dangling, we have to use our core and leg muscles in order to maintain balance, leading to difficulty relaxing the pelvic floor.

Use stools or ‘squatty potties’ to provide the legs with support. Ideally, your knees should be at hip level or higher. Your pelvis should be slightly tipped forward and your trunk should be up tall and slightly leaned forward. This posture places your body in the optimal position to relax the pelvic floor and fully empty your bowel and bladder. 

 

Source: @oxotot

 

6. Get help if you need it

So, when do we need to see our doctor? And how does physical therapy come into play? If you are practicing the above behaviors and your child still has pain with voiding, frequent accidents, or chronic constipation, it may be beneficial to speak with your doctor. They may refer you to a pediatric urologist to ensure that there isn’t anything more medical at play.

Additionally, he or she may refer you to a physical therapist to work on improving voiding habits and pelvic floor muscle function. Pediatric pelvic floor physical therapy is very similar to physical therapy for any other diagnosis; we work on stretching, strengthening, behavior modification, postural education, and breathing mechanics. Pediatric pelvic floor physical therapy differs from adult pelvic floor physical therapy in that it is completely non-invasive. Your doctor will work with you to find the best course of treatment for you and your family. 

 

Read More: Curious About How Pelvic Floor Therapy Can Help Postpartum Recovery? Read This

 

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