Children's Pelvic Health

Children’s Pelvic Health

DID YOU KNOW….

25% of all pediatric visits are for bowel and bladder dysfunctions?

The most common pediatric referrals are for:

  • Constipation (Encopresis)
  • Daytime or Bedwetting (Enuresis)
  • Urinary Dyssynergia
  • Hirschsprung’s Disease
  • Imperforate Anus

FUNCTIONAL CONSTIPATION (FC) IN PEDIATRICS

For a diagnosis of Function Constipation, a child must posses 2 or more of the following:

  • Two or fewer defecations per week
  • at least 1 episode of incontinence per week
  • history of retentive posturing or excessive volitional stool retention
  • history of painful or hard bowel movements
  • presence of large fecal mass in the rectum
  • history of large diameter stools that may obstruct toilet

The longer FC goes unrecognized the less successful the treatment. Incontinence is one of the most common presentations of FC in children (up to 84%). Sometimes referred to as False Incontinence

PEDIATRIC ENCOPRESIS

The repeated passage of feces in inapproprate locations. Incontinence must occur at least once a month for a minimum of 3 months. The child must be at least 4 years of age.

53% of constipated children have non-relaxation or pradoxical contraction of the anal sphincter during attempts at defecation, associated with poor abdomino-pelvic muscle recruitment patterns. This is known as rectosphincteric dyssynergia. 17% of these cases are victims of sexual abuse.

HIRSCHSPRUNG'S DISEASE

A rare congenital disorder that affects a small part of the lower colon due to a lack of appropriate neurological input. The area behind the constriction becomes swollen and predisposed to the over accumulation of feces or inappropriate evacuation efforts. This occurs more often in boys.

URINARY DYSYNERGIA

Absence of sphincteric relaxation at micturition. When advanced, can cause bladder diverticulum, reflux, trabeculation. May lead to: Dysuria (painful or uncomfortable micturition), Overflow incontinence or Cystitis (inflammation of bladder).

IMPERFORATE ANUS

AKA. Atresia, prevalence: 1/5000 births. More boys than girls. Lesion may be high or low. Congenital defect e.g. Currarino syndrome.

  • Infra-levator. Puborectalis, striated and smooth anal sphincter are present.
  • Supra-levator. Rectum, internal sphincter and vasculo-nervous bundles are absent. Puborectalis and striated sphincter are hypoplasic. Prognosis for continence less favorable.

POTTY TRAINING

SIGNS THAT CHILD IS READY TO POTTY TRAIN

  • Having a BM around same time each day
  • No BMs at night
  • Dry diaper after a nap
  • Dry diaper for at least 2 hrs at a time
  • Gross MOTOR Signs
  • Ability to low squat
  • Climbing
  • FINE motor Signs
  • Able to do fasteners (buttons)
  • Able to pull down pants/underwear
  • Emotional Readiness
  • Child must have an emotional stake in toilet training. If they don’t, try and increase their desire to do so. If child has an accident, have the child take the diaper and empty it in the toilet to reinforce positive behaviours