5 signs your child’s constipation needs Pelvic Floor Therapy
Constipation is common in children, but when it becomes chronic or difficult to manage, there may be more going on than simply not eating enough fiber or drinking enough water.
One piece that is often overlooked is how the pelvic floor muscles work during a bowel movement. These muscles need to relax and coordinate with the abdominal muscles to allow stool to pass. If a child has difficulty relaxing or coordinating these muscles, constipation can become a frustrating cycle.
Here are five signs that your child may benefit from a pelvic floor therapy evaluation.
1. Your child regularly holds their poop
Does your child hide, stiffen their body, cross their legs, stand on their toes, squeeze their bottom, or otherwise try to avoid having a bowel movement?
Stool withholding can cause stool to become harder and more difficult to pass. Over time, children can develop a habit of tightening their pelvic floor muscles when they actually need to relax them.
Pelvic floor therapy can help children recognize their body's signals and learn strategies for relaxing their muscles during toileting.
2. Your child strains or has difficulty getting poop out
Some children sit on the toilet for a long time, push very hard, or repeatedly try to have a bowel movement without much success.
Sometimes the problem isn't simply a lack of strength. A child may be pushing while simultaneously tightening the muscles that need to relax.
A pelvic floor therapist can assess breathing, abdominal pressure, posture, and pelvic floor coordination to determine whether these factors may be contributing to difficulty passing stool.
3. Your child has frequent stool accidents or encopresis
Frequent stool leakage or accidents can be a sign of chronic constipation, even when your child is having bowel movements every day.
When stool remains in the rectum for an extended period, softer stool can sometimes leak around the retained stool. Children may not always feel or recognize that this is happening.
Treatment may involve working with your child's medical provider on constipation management while occupational therapy addresses toileting habits, body awareness, positioning, relaxation, and pelvic floor coordination.
4. Your child says they don't feel the urge to poop
Some children seem to have difficulty recognizing when they need to have a bowel movement.
Chronic constipation can affect how the rectum responds to stool, and some children may also have difficulty interpreting internal body sensations, sometimes called interoception.
Pelvic floor occupational therapy can help children learn to recognize and respond to their body's signals while developing consistent toileting routines.
5. You've tried everything, but constipation keeps coming back
You've increased fiber. You've encouraged water. You've tried scheduled toilet sits. You've worked with your pediatrician. Maybe medications have helped, but the constipation continues to return.
If constipation is persistent despite appropriate medical management, it may be worth looking at the functional and muscular aspects of toileting.
A pelvic floor therapist can look at the whole picture, including:
Toilet positioning
Breathing patterns
Abdominal and pelvic muscle coordination
Pelvic floor relaxation
Body awareness and urge recognition
Sensory factors
Toilet avoidance or fear
Daily toileting routines
When Should You Consider Pelvic Floor Therapy?
Pelvic floor therapy isn't necessary for every child with constipation. However, it may be helpful when constipation is chronic, recurrent, associated with withholding or accidents, or not improving with standard management.
Pediatric pelvic floor occupational therapy is typically most effective as part of a team. Your child's pediatrician or other medical provider can help determine whether additional medical evaluation or constipation treatment is needed, while an OT can address the skills and behaviors involved in successful toileting.
The good news?
Constipation doesn't have to be a constant battle.
With the right support, children can learn how to recognize their body's signals, relax their muscles, develop healthy toileting habits, and feel more confident using the bathroom.
If your child is struggling with chronic constipation, stool withholding, or toileting difficulties, consider talking with your pediatrician and asking whether a pediatric pelvic floor therapy evaluation may be appropriate.
