Peds Level 1 — Treatment of Bowel and Bladder Disorders: Evaluation and Treatment of Dysfunctional Voiding, Bedwetting, and Constipation

Course Description

According to the International Children’s Continence Society (ICCS) children should have daytime and nighttime bladder control by age 5 for a typically developing child1.  The frustration, anxiety, lack of self-esteem as well as the development of internalizing and externalizing psychological behaviors of these families who have not achieved this milestone is significant and needs to be dealt with.

The most common pelvic floor dysfunctions in the pediatric population are dysfunctional elimination syndrome, withholding, UTI’s and bedwetting. Constipation is also a contributor to urinary leakage or urgency and bedwetting and with nearly 5% of pediatric office visits occurring for constipation, the need to address these issues is great.

The pediatric population is greatly underserved causing undo stress for the child and family.

This course focuses on the treatment of children with day or nighttime incontinence, fecal incontinence, and/or dysfunctional voiding habits. Children with special needs, Sensory Processing disorders or musculoskeletal asymmetries frequently develop poor bowel and bladder habits including constipation.

As pediatric bladder and bowel dysfunction can persist into adulthood, pelvic rehabilitation providers must direct attention to the pediatric population to improve the health in our patient populations.

This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. Common causes of incontinence in the pediatric patient will be covered. The participant will learn medical and therapy evaluation concepts for bowel and bladder dysfunction, bedwetting and constipation. 

A comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor using surface electromyography (SEMG) biofeedback, rehabilitative ultrasound imaging, as well as pediatric pelvic floor external manual techniques to teach proper evacuation.

Case studies will be presented to compliment the course with evaluation, treatment examples based on diagnosis and progressions through discharge.

References:

1. Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn. 2016;35:471–81
2. Thibodeau, B. A., Metcalfe, P., Koop, P., & Moore, K. (2013). Urinary incontinence and quality of life in children. Journal of pediatric urology, 9(1), 78-83.
3. Chase J, Bower W, Susan Gibb S. et al. Diagnostic scores, questionnaires, quality of life, and outcome measures in pediatric continence: A review of available tools from the International Children’s Continence Society. J Ped Urol (2018) 14, 98e107
4. Constipation in Children. (2013).
5. Little LM, BenSenspryton K, Manuel-Rubio M, Saps M, Fishbein M Contribution of Sensory Processing to Chronic Constipation in Preschool Children. J Peds. 2019

Instructional Level

This is a beginner level course.

Course Prerequisite

This course is appropriate for physical therapists, occupational therapists, pediatric nurse practitioners and medical doctors and other health care professionals interested in expanding their practice in pediatric bowel and bladder disorders.

Content is not intended for use outside the scope of the learner’s license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Course Objectives

Upon completion of this continuing education seminar, participants will be able to: