CHILDREN’S CONTINENCE PHYSIOTHERAPY

Most children gain bladder and bowel control by age 4 or 5. At Better Health we strive to improve the quality of life for children, young people and their families who suffer from the consequences of wetting and soiling difficulties, to help them manage or overcome these problems. We believe that no child or young person should suffer unnecessarily because of a wetting or soiling problem. It is important for children and families that suffer from these issues that they are able to receive the support, understanding, information and treatment they need.

Over time, bladder and bowel problems can often correct themselves. However, research has shown that this distressing condition can have far reaching effects on the emotional well-being and social development of children. It can prevent children and adolescents from fitting in, for example by stopping them having sleep overs and attending school trips. Therefore, we recommend that all children over 5 with symptoms should be assessed by a health professional with specialised training in children’s continence.

COMMON CONDITIONS WE TREAT

Wetting during the day (children over 5)

Daytime wetting affects 3-5% of 5 to 17 year olds. It is usual for younger children to have wetting accidents as part of the toilet training process but as children get older, daytime wetting can be more difficult to manage at school or in social situations.

Wetting at night (children over 6)

Bedwetting is a common condition and 21% of children aged four and a half years and 8% of nine and a half years wet the bed occasionally.More frequent bedwetting is known to affect 8% at four and a half and only 1.5% will still have the problem at nine and a half (Butler and Heron 2008).

Needing the toilet many times during the day

Children usually pass urine once every two to four hours. There could be a problem if they need to go more often than that. Often this can be associated with urgency (needing to pass urine quickly) and incontinence.

Constipation

Constipation is very common in children and for many there is no known reason why it happens. A child is considered to be constipated when they poo less than four times a week, and is most common in toddlers and pre-school age children. It is important to tackle it at this early stage to prevent it becoming chronic and having a long-term impact on children’s health and wellbeing.

Soiling underwear

Soiling is usually a symptom of constipation and requires treatment to remove the hardened poo in the bowel and to keep the bowel clear. Soiling can happen several times a day as the child does not always receive the message that they need a poo or is not always aware that the poo has come out.

If a child of school age regularly experiences these problems, we would recommend they be assessed by a physiotherapist with specialised postgraduate training in childhood continence issues.

EXAMINATION & TREATMENT PROTOCOLS

At Better Health we provide a thorough one-hour individualised non-invasive assessment to assess the child’s bladder, bowel and pelvic floor. The purpose of this assessment is to provide a specific diagnosis and treatment plan for children and teenagers with bladder and bowel conditions.

The assessment may include:-

abdominal real time ultrasound
urine testing
a bladder or bowel diary may be provided to complete at the follow up visit

The assessment will occur if a private room with the child and parent/s. If possible, it is recommended that younger siblings remain at home or are minded in the waiting room with another adult supervising them. Older siblings can sit outside in the waiting room if they do not need constant supervision. It is really important that the child receiving treatment is not distracted and that their assessment and treatment are not compromised.

Bladder Training

Teaching your child good bladder habits.

Dietary Advice

Including fluid and dietary modifications.

Toileting Advice

Including correct toilet positioning.

Bowel Management

Establising a regular bowel routine.
Checking that your child is positioned comfortably and securely on the toilet (use a child seat if necessary, and ensuring that feet are firmly on the floor or supported on a step.
Advice regarding laxatives or stool softeners if required.

Pelvic Floor Training

Teaching pelvic floor exercises at an age appropriate level. May include using real-time ultrasound (a non-invasive treatment) to evaluate the pelvic floor.

Bed Wetting Alarms

These are sometimes useful for children who are distressed by bed-wetting. They are night alarms that go off when a child starts to wet. These work be teaching the child to wake to the feeling of a full bladder. The alarm is used either on the bed or in the child’s underpants. They work best when the child is motivated and wants to be dry.

TENS

Transcutaneous electrical stimulation is a non-invasive, pain-free, safe treatment for urinary frequency and urgency. It is safe to use in adults and children.

PHYSIOTHERAPY

GENERAL PHYSIOTHERAPY

ANTENATAL / POSTNATAL PHYSIOTHERAPY

WOMEN’S HEALTH PHYSIOTHERAPY