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

A comprehensive course to evaluate and treat Dysfunctional Voiding, Bedwetting, Constipation and More!

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.


  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 urology9(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:

  • List 2 muscles groups and describe 3 functions of the pelvic floor 

  • Understand the development of normal urinary control in pediatrics

  • Understand medical red flags for abnormal voiding and when to refer to medical doctor

  • List the 4 phases of defecation and describe the rectal anal inhibitory reflex

  • Identify common causes of constipation and its’ relationship to bladder dysfunction

  • Perform soft tissue techniques for constipation

  • Describe the pelvic floor relationship to voiding reflexes.

  • Understand pediatric urology terminology and investigative tools used for testing the pediatric patient for differential diagnosis

  • Discuss education and treatment about diet including bladder health and bladder retraining

  • Understand pediatric pelvic floor dysfunctions on SEMG as it relates to bowel and bladder function

  • Identify the need for referral based on SEMG findings and visual PFM assessment

  • Evaluate the effects of posture and positioning on pelvic floor muscle recruitment and relaxation.

  • Understand the psychological effects of bedwetting, daytime urinary incontinence and fecal incontinence and know when to refer to appropriate practitioners.

  • Describe behavioral treatments or Urotherapy for pediatric pelvic floor dysfunctions.

  • Understand the use of surface electromyography (SEMG) in the pediatric patient.

  • Develop treatment progressions for children with pediatric bowel and bladder dysfunction.

  • Perform verbal instruction of pelvic floor activation

  • Perform 3 different diaphragmatic breathing techniques for pediatric patients including diastasis rectus abdominis assessment with examples of core activation.

  • Discuss the effects of toileting postures on pelvic floor muscle recruitment and relaxation

Every journey starts with the first step.