Question
What are the common causes of pediatric incontinence, and how can physical therapists effectively address them, including identifying symptoms that require immediate medical attention?
Answer
Pediatric incontinence often stems from several underlying mechanisms, including constipation, incomplete relaxation of the pelvic floor during voiding, behavioral factors, and sensory overload. These issues can manifest in various ways and require specific interventions to manage effectively.
1. Constipation: Constipation is the most common cause of pediatric incontinence. When a child is constipated, the large volume of stool in the rectum can press against the bladder, reducing its capacity and signaling ability. This can lead to both daytime and nighttime incontinence. To address this, physical therapists can implement dietary changes to increase fiber intake, encourage hydration, and use strategies like the "Eat the Rainbow" approach to ensure a varied and balanced diet. In addition, therapists may recommend pelvic floor muscle training and exercises to promote regular bowel movements and proper pelvic floor relaxation during voiding.
2. Incomplete Relaxation of the Pelvic Floor: Some children have difficulty fully relaxing their pelvic floor muscles during voiding, which can lead to incomplete bladder emptying and subsequent incontinence. Physical therapists can use biofeedback and manual therapy techniques to help these children learn to relax their pelvic floor muscles effectively. Techniques might include external palpation and exercises to coordinate pelvic floor relaxation with voiding.
3. Behavioral and Sensory Factors: Behavioral factors, such as withholding urine due to previous painful urination or bowel movements and sensory overload, can also contribute to incontinence. Children with sensory processing disorders or neurodiversity (e.g., ADHD, autism) may have heightened sensitivity that makes using the bathroom an unpleasant experience, leading to avoidance behaviors. Therapists can work on desensitization techniques, provide a supportive and understanding environment, and incorporate sensory integration methods to make bathroom use more comfortable.
Red Flags for Medical Referral: While many cases of pediatric incontinence can be managed with conservative treatments, certain symptoms warrant immediate medical attention. These include:
- Dysuria (pain with urination)
- Genital pain or discharge, especially if the discharge is odorous or significant in volume
- Straining to urinate
- Unexplained fever, night sweats, or chills
- Signs of abuse, particularly in cases where previously continent children begin wetting the bed again
These symptoms may indicate underlying medical conditions, such as urinary tract infections, anatomical abnormalities, or psychosocial issues, that require further evaluation by a pediatrician or a pediatric urologist.
Physical therapists play a crucial role in managing pediatric incontinence through targeted interventions that address the multifactorial nature of the condition. By identifying the underlying causes and implementing appropriate strategies, therapists can significantly improve outcomes for children and their families.
This Ask the Expert is an edited excerpt from the course, "Tools to Positively Impact Pediatric Incontinence," presented by Jennifer Stone, PT, DPT, OCS, PHC.
