Pelvic Health Screen for Pediatric Physical & Occupational Therapists

Learn the top 5 questions you can ask your patients in under a minute to determine their need for pelvic health intervention.

Day in and day out you’re working with kiddos to improve fine and gross motor skills. You’re the one parents trust to guide them on their way to the best functional outcomes possible for their children. If it weren’t for you, your patients and their families would be left struggling to navigate their special needs.

You’re an amazing asset to your patient’s care team, but could you bring even more to the table? Did you know you can quickly and easily determine whether a patient may benefit from pelvic floor physical therapy with just a few questions?

You were taught in OT or PT school to ask about “bowel and bladder issues” during your initial evaluations. In adults, you’re primarily screening for neurologic issues when you ask this question. In children there is a bit more to it.

When you ask about bowel and bladder issues with your pediatric patients, you’re screening for issues beyond cauda equina and low back pain. Pelvic health in children is paramount to their overall health. Undiagnosed pelvic health problems can lead to life-long dysfunction and irreversible damage.

What may seem like small or temporary issues, like bedwetting and constipation, can actually have life-long impacts on children. Withholding, overactive bladder, incontinence, bowel bladder dysfunction, and daytime wetting are other issues addressed by pediatric pelvic health therapists.

These issues have a variety of etiologies. Some are neurologic, others autoimmune, and most are non-neurologic physiologic changes that result in the dysfunction. Which is great news — it means you can have an enormous impact on most of the pediatric pelvic health issues your patients are facing!

You may or may not already be asking parents about their child’s toileting during your initial evaluation. Simply knowing whether or not your patient needs diapers during the day or night can help inform you about their therapeutic needs.

Do they need to work on hip strength to get on and off the toilet? Core strength to stay seated? How about balance to put their legs in and out of their shorts?

But beyond assisting your pediatric patients with clothing management or maybe the gross motor skills needed to sit on the toilet, there is a whole world of knowledge you can tap into in order to help your patients in a much more holistic way.

How many patients have these pelvic health issues, though? Anywhere from 1-31% of children suffer from constipation.1 There is wide variation in the literature because of varied reporting standards. 5-7 million children in the United States alone are affected by enuresis or bedwetting each year. Of those, up to a quarter of them also struggle with wetting during the day and 10-25% of children with enuresis also have problems controlling their bowels.

You’re one of few providers who get to spend quite a bit more time with your patients. On average, pediatricians spend as little as 9, but up to 17 minutes with a patient for office visits.2 This is simply not enough time to dig into pelvic health questions and get to the root of any pediatric pelvic health concern.

Pediatric physical and occupational therapists have a unique opportunity to be physician-extenders and investigate pelvic health issues in the pediatric population. 

The way we as providers inquire about bowel and bladder issues is important, though. Simply asking, “Does your child have any issues with their bowel or bladder?” is not enough.

Many times, when asked in this way, parents respond with a “no” due to one of two reasons:

1. They are not aware there’s an issue, or 
2. They know there is an issue but they think they’ve exhausted all the help there is available

For example, a parent may have mentioned their child’s constipation to their pediatrician and been prescribed a regimen of laxatives.

The child begins to have more regular bowel movements and the parent thinks the problem is now “solved”. In reality, laxatives are a BandAid of sorts, and don’t get to the root of the issue.

Alternatively, parents may have mentioned their child’s pelvic health issue to a doctor or other provider and been given poor advice or worse, no advice. They will often resolve to keep their child in diapers to end the exhausting cycle of washing sheets several times a week, and just hope their child ”grows out of it”.

In order to know what your patients need, you need to be asking the right questions. You’ll likely be surprised at how many of your current patients have pelvic health issues once you know the right questions to ask.

I have a full 18-item questionnaire I give to my students who sign up for my entry level Pediatric Pelvic Health course. I’ve taken what I believe to be the top 5 questions you should be asking every one of your patients to screen for pelvic health concerns and listed them below.

These questions will help you, your patients and their parents become aware of any underlying pelvic health concerns that should and can be addressed. Start asking your new patients these questions in clinic tomorrow:

1. Do you usually pee less than 4 times a day?
2. Do you ever leak pee when you sleep at night?
3. Do you poop less than 3 times per week?
4. Do you ever have to push hard or strain to make your poop come out?
5. Some children are embarrassed, feel anxious or don’t do things with friends because of pee or poop problems. Has this been a problem for you in the past month?

If your patients or their parents answer “yes” to any of the above questions, further discussion is warranted. Pelvic floor therapy is by far the best place to start with “yes” answers to any of the above questions.

Once you’ve identified pelvic health concerns, you can refer your patients to a pediatric pelvic health therapist. The number of professionals with pediatric pelvic health training is growing, but still considerably small.

You can learn more and find local providers by joining either of the following Facebook groups: Pediatric Pelvic Health Occupational Therapists and Pediatric Pelvic Health Physiotherapy.

You can also direct parents to visit the APTA PT locator or Find an Occupational Therapist to locate pelvic floor therapists treating children in your area.

Another option you have is to become a pediatric pelvic health therapist yourself! With zero pelvic floor experience, you can learn how to evaluate and treat the most common pediatric pelvic floor dysfunctions. I offer live courses in-person and via zoom. I also have online courses you can purchase and work through at your own pace.

It’s never been easier to start treating pelvic floor conditions in the pediatric population. With over 30 years of experience in the speciality, you won’t find a more comprehensive course out there. I am still treating patients and regularly update my courses to keep up with current evidence and best practice.

Additionally, I offer 1:1 consultation services for therapists and other healthcare professionals treating pediatric patients with pelvic floor conditions. I am available for live consultations with patients present or zoom/phone calls separate from patient visits to discuss specific cases on an as-needed basis.

My challenge for you this week is to ask at least one new patient about their bowel and bladder habits with more specific and targeted questions. Let me know if you learn something new or surprising!

Sources

1.  Ferreira-Maia AP, Matijasevich A, Wang YP. Epidemiology of functional gastrointestinal disorders in infants and toddlers: a systematic review. World J Gastroenterol. 2016;22:6547–6558.
2. Data courtesy of Medscape’s 2017 Physician Compensation Report via staffcare.com