Pelvic Floor Exercises in Children

What are Pelvic Floor Muscles?

They are the muscles that surround the cavity in which our urogenital organs are located and which we call the pelvis and around the anus and bladder neck and urethra. These muscles play an important role in the realisation of the functions of the bladder, urethra, intestines, especially the last part of the large intestine. Thus, they are muscles with special functions in urine and faecal continence. In children, pelvic floor muscles continue their functional development. Therefore, correct and healthy functioning of these muscles plays an essential role for healthy development and urinary and faecal continence.

Since it is still in the process of development, the correct functioning of these muscles is important for healthy growth.

What are the Functions of Pelvic Floor Muscles?

These muscles basically undertake very important tasks for three main functions.

1. Providing proper shape and posture development and balanced movement of the body
2. Urinary continence
3. Faecal continence

They are also muscles that have important functions in sexual functions in adults and during labour in pregnant women. Anatomical and functional disorders of these muscles may cause pathologies in all these functions. On the other hand, these pathologies can cause serious, psychological, sociological and physiological damage to the individual. All these disorders can be learnt from the relevant branch physicians. Here, we will focus on urinary and faecal continence, which is more related to paediatric surgery.

How do pelvic floor muscle problems in children manifest themselves?

Related problems can usually manifest themselves as difficulty in bladder (urinary bladder) control. This can manifest itself in the form of nocturnal or daytime urinary incontinence, urge incontinence, inability to empty the bladder completely and urinary tract infection. For detailed information, our related articles can be read.

It can also be the cause of faecal incontinence.

On the other hand, pelvic floor muscles support body posture. Weakness in these muscles can cause posture disorder, and incorrect posture or continuous sitting habits can weaken the pelvic floor muscles and affect their functions. This can cause urinary and defecation problems and body posture disorders. Weakness in the pelvic floor muscles can cause pain problems in the pelvic region, although very rarely in children.

What are the Benefits of Pelvic Floor Exercises?

Pelvic floor exercises have a healthy effect on children. These exercises not only regulate the function of the pelvic floor muscles in the child, but also positively affect the physical and psychological development of the child. For example;

1. Pelvic floor exercises regulate the solution of urinary and faecal control problems in children
2. It prevents constipation or contributes positively to its treatment.
3. Pelvic floor exercises contribute to the correction of posture disorders in children and ensure that the child has a proper body structure.
4. It ensures that the child is physically emotionally self-confident by correcting poop and urine problems and having a proper body structure.
5. Pelvic floor exercises help to increase children's self-confidence.
6. Pelvic floor exercises performed at an early age prevent future pelvic organ sagging and problems related to sexual functions.

How Should Pelvic Floor Exercises Be Suitable for Children?

Pelvic rehabilitation movements in children should be suitable for children, motivating them, simple, effective and playful. These exercises should contribute to the physical and mental development of the child. The child should feel the effect of the movements he/she does and the physiotherapist or nurse who will help him/her in this regard should also be selected from people who know child psychology, anatomy and physiology.

When Should Children Start Pelvic Exercises?

Experts who are interested in this issue should give this subject without forgetting that each child is different (anatomical, physiological, mental and psychological) individuals. In general, the ideal period for children to start pelvic floor exercises is immediately after toilet training. The period between the ages of 4-6 is a suitable time for children to learn to control the pelvic floor muscles.

How to Understand the Benefit of Pelvic Exercises in Children?

The success of pelvic floor exercises is directly related to the success of starting with the physical and emotional readiness of the child and the family. For this reason, detailed explanatory information should be given by the specialist physician and physiotherapist with visuals if necessary.

The success of the therapy is not an immediate result after a few sessions. The treatment process requires patience and it is important that the person attends the therapy regularly. In addition, in some cases, more than one treatment method or exercises that can be done at home recommended by the therapist should be done regularly and changes in lifestyle should be continued. Pelvic Floor Exercises have a higher success rate in the following cases.

1. Congenital damage to the pelvic floor muscles and nerves as in spina bifida
2. Conditions that have recovered after surgery and require pelvic floor support (after anal atresia and teratoma surgeries).
3. The child feels pain and discomfort at the beginning of exercise.
4. Reduction or elimination of clinical complaints with the application
5. Improvement in pelvic muscle function
6. Improvement in quality of life.

In which diseases can pelvic floor physiotherapy be applied in children?

Urinary System Diseases;

• Overactive bladder and related urinary incontinence
• Vaginal reflux
• Gigle incontinence
• Lazy bladder
• Neurogenic bladder
• Nocturnal enuresis
• Dysfunctional voiding

Gastroenterological Diseases;

• Chronic constipation
• Rectal Prolapse 
• Poop Incontinence
• Pelvic floor strengthening after colostomy surgeries

How is Pelvic Floor Physiotherapy Performed in Children?

The detailed background of the child to be pelvic floor exercise is evaluated by the specialist physician and physiotherapist. Then the physician performs a detailed physical examination of the child. Then, the family and the child are patiently and in detail informed, and the information is repeated at intervals of a few days if necessary.

Afterwards, some tests are performed according to the patient's condition. Routine examinations include uroflowmetry (voiding test), urinalysis, urine culture, urinary system ultrasonography, functional measurement of pelvic floor muscles and daily bladder/bowel routine diaries. The bladder and bowel diary contains headings that help to question how often your child urinates during the day, how much urine he/she misses at night and how his/her bowel movements are. In the light of this information, it creates an optimal bladder and bowel plan for the child.

How is Pelvic Floor Muscle Strength Measured?

The activities of the pelvic floor muscles are performed by means of the device we call EMG. If the procedure is accompanied by urodynamics, both the urinary system and pelvic muscles are evaluated.

How to do Pelvic Floor Exercise Therapy in Children?

Pelvic Floor Rehabilitation: Many methods such as manual therapy, electrical stimulation, Emg-Biofeedback, exercise, correct straining-urination techniques are used in treatment. The pelvic floor muscles that control urination and defecation should be evaluated and trained correctly with the appropriate programme. Techniques that help urination are taught. Poop incontinence may decrease or even disappear.

Treatment Titles to be used in Pelvic Exercise can be listed as follows;

• Posture treatments and breathing exercises
• Manual treatment methods
• Thoraco-lumbal (trunk-lumbar region) exercises
• Pelvic floor muscle strengthening exercises
• Exercises to facilitate urination and defecation
• Relaxation and relaxation techniques
• Behavioural and toilet training
• Nutrition and weight monitoring
• Many treatment modalities such as Emg-biofeedback are applied.

In the meantime, the family and the patient are given the necessary behaviour, nutrition and toilet training to be done at home and asked to comply with them.

How should follow-up be after pelvic floor physiotherapy?

Remember that most of the time the underlying causes are not completely organic causes, so when this organic cause is eliminated, the problem will disappear so that it will not recur again. The main problem is the acquisition of some habits, so we need to continue this habit and lifestyle after treatment.

How is it decided to terminate the treatment?

The termination of pelvic floor exercise treatment should be decided by the child, family and treatment practitioners (physiotherapist, physician) together. The habits learnt should become a way of life, otherwise the result obtained will be a temporary success and the child's complaints may recur.

*** The information provided here, the content of the website has been organised for the purpose of informing the visitor, especially the families. No information should be considered as advice by the visitors and should not lead to any decision or action. Families should definitely have their patient examined by a paediatric surgery specialist, consult with him/her and make a decision by consulting his/her knowledge.