According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), by 5 years of age, over 90% of children have daytime bladder control. What is life like for the other 10% who experience urinary leakage during the day? Bedwetting is another pediatric issue with significant negative quality of life impact for children and their caregivers, with as much as 30% of 4 year-olds experiencing urinary leakage at night. Children who experience anxiety-causing events may have a higher risk of developing urinary incontinence, and in turn, having incontinence causes significant stress and anxiety for children. (Thibodeau et al., 2013) Having bowel dysfunction such as constipation is also a contributor to urinary leakage or urgency, and with nearly 5% of pediatric office visits occurring for constipation, the need to address these issues is great. (Constipation in Children, 2013) 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.
The pediatric population is greatly underserved causing undue stress for the child and family as well as development of internalizing and externalizing psychological behaviours. The two most common pelvic floor dysfunctions in the pediatric population are dysfunctional elimination syndrome and bedwetting. This specialty continuing education course focuses on the treatment of children with day or nighttime incontinence, fecal incontinence, and/or dysfunctional voiding habits.
This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. The participant will learn terminology from the International Children’s Continence Society, medical evaluation concepts for bowel and bladder dysfunction, and common dysfunctions in voiding and defecation. Common causes of incontinence in the pediatric patient will be covered, and a comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor and surface electromyography (or SEMG, a form of biofeedback) as well as a breathing and bowel massage lab.
Upon completion of this course, participants will be able to:
- List 2 muscle groups and describe 3 functions of the pelvic floor.
- Understand the development of normal urinary control in pediatrics.
- 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 visceral and 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.
- 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.
- 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.
- Describe behavioural 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.
In an effort to provide you with more video demonstrations and labs we will be asking that you watch the online lectures that will be provided and complete the required pre-readings/assignments prior to the class. This includes the online PowerPoint voiceover lectures and bladder diary prior to coming to the course. This will not be instructed in class and the class will not make sense to you if you have not prepared.
Prerequisites: There are no prerequisite courses. This is a beginner level course.
Audience: This course is open to physiotherapists, occupational therapists, physicians and nurses. Content is not intended for use outside the scope of the learner’s license or regulation. This course should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.
Please Note: This course is both lecture and lab format.
Constipation in Children. (2013). Retrieved June 9, 2014 from http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/#common
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.
Urinary Incontinence in Children. (2012). Retrieved June 9, 2014 from http://kidney.niddk.nih.gov/kudiseases/pubs/uichildren/index.aspx
Pediatric Incontinence October 2023
Date/Time: Two-day live-online course on October 21-22, 2023 from 11:00am-7:00pm ET (Toronto). Please convert to your local time zone.
Dawn Sandalcidi, PT, RCMT, BCB-PMD
Dawn specializes in pelvic muscle dysfunction (incontinence and pain), orthopedic manual therapy, and TMJ treatment. She is the leading expert in the field of pediatric incontinence in physical therapy. She has trained medical professionals in manual therapy since 1992 both nationally and internationally. Dawn is certified by the Biofeedback Institute of America for pelvic muscle biofeedback treatment.
Dawn has actively been treating patients for the past 32 years and owns a private practice in Denver, Colorado, develops educational materials for health care providers through Progressive Therapeutics and provides consulting services through Physical Therapy Specialists. In addition she is an affiliate faculty member at Regis University Department of Physical Therapy in Denver, CO where she teaches pelvic muscle dysfunction/ women’s health physical therapy, as well TMJ.
Dawn received her degree in physical therapy in 1982 from SUNY Upstate Medical Center in Syracuse, New York. She participated in extensive international postgraduate studies in manual and manipulative therapy of the spine and extremities in Germany, Switzerland and New Zealand. In 1992, Dawn completed an additional two-year residency to become a certified instructor of the Mariano Rocabado techniques for the spine, pelvis and craniomandibular joints (RCMT). Dawn also received her BCB-PMD Board Certified Biofeedback in Pelvic Muscle Dysfunction.