What is Urinary Incontinence (Bladder Leakage)?

Uncontrolled urine leakage that may be continuous or occur intermittently throughout the day. It can be classified as primary (in children who have never achieved daytime dryness) or secondary (in those who were previously dry but developed incontinence later).

What Causes Urinary Incontinence?

Primary incontinence can result from weak or uncoordinated pelvic floor muscles, constipation, poor bladder sensation, anatomical abnormalities in the ureters or urethra, or nerve damage. Secondary incontinence may be triggered by life changes such as a new sibling, family stress, or moving.

Treatment Approach

Understanding the cause of incontinence is key to treatment. Your therapist will assess your child’s bladder habits and address issues like pelvic floor coordination, constipation, diaphragm control, and interoception (sensation of an urge). If needed, further testing may be recommended to rule out anatomical or nerve-related causes.

What is Enuresis?

Enuresis is defined as intermittent incontinence episodes that occur while sleeping. This is typically diagnosed after the age of 5 as bedwetting is considered typical until the age of 6. 

What Causes Enuresis?

Enuresis is caused by many factors including decreased sensation of a full bladder while sleeping, obstructive sleep disorder/condition, decreased hormone production that helps with fluid retention overnight, decreased coordination of pelvic floor muscles, and decreased bladder capacity.

Treatment Approach

Your therapist will first seek to rule out any hormonal causes of enuresis. They will then work with parents to identify details about when leakage occurs in order to create a void schedule to slowly increase bladder capacity in addition to training coordination of pelvic floor muscles. The child will also learn how to effectively sense an urge to urinate to reduce the frequency of early morning leaks.

What is constipation?

Constipation is the retention of feces in the rectum and associated with difficulty emptying bowels. Stool is typically hard but can also fluctuate between hard and diarrhea types. The rectum can become enlarged if constipation has been present long enough which can lead to decreased sensation in the rectum and bowel leaks.

What causes constipation?

There are many causes to constipation, one misconception is that if your child has a daily bowel movement that they are not constipated. Common causes of constipation include inadequate fiber intake, dehydration, lack of physical activity, difficulty with coordination of pelvic floor muscles, food intolerances/allergies, and sensory aversions. 

Treatment Approach

The primary focus of treating constipation is to promote improved transit of stool in the intestines, decrease straining when bowel movements occur and appropriate positioning when having a bowel movement to promote effective emptying. This is addressed with assessment of fluid intake, fiber intake, coordination of pelvic floor muscles, sensory training, physical activity, and appropriate coordination of diaphragm.

What is Urinary Urgency?

A sudden, intense urge to urinate, often with bladder pressure or discomfort. May or may not be accompanied by urinary frequency and/or leakage.

What Causes Urinary Urgency?

UTIs, constipation, and overactive bladder are common causes, but anxiety, high fluid intake, and certain foods that cause bladder inflammation/irritation can also contribute.

Treatment Approach

Your therapist will work with you and your child in identifying the cause of the urgency, which starts with checking for constipation and reviewing diet and fluid intake. Treatment also focuses on improving pelvic floor muscle coordination with core and diaphragm strengthening.

What is dysmenorrhea (painful periods)?

Dysmenorrhea is pain during menstruation often accompanied by lower abdominal cramps, back pain, leg pain, muscle weakness, nausea, and/or fatigue. Primary dysmenorrhea is common in teens with no underlying cause. Secondary dysmenorrhea is caused by conditions like endometriosis or fibroids.

What causes dysmenorrhea?

Primary dysmenorrhea is common in teens caused by hormonal changes related to increased prostaglandins, a hormone that can cause uterine contractions and abdominal cramping. Secondary dysmenorrhea is caused by conditions like endometriosis, fibroids, or pelvic inflammatory disease

Treatment Approach

Coordination training of pelvic floor muscles to relax to reduce muscle tension and pain, massage techniques to release muscle spasms and self management of abdominal pain, central nervous system calming, diaphragm training to assist with muscle tension and pelvic floor coordination, adjusting body mechanics to help reduce strain on pelvic floor muscles.