Youth Pelvic Health Physiotherapy in Guelph & Wellington County

“Bathroom accidents,” such as leaking urine or stool during the day or bedwetting at night, are common in children but aren’t often talked about. Late-night sheet changes, extra laundry, and planning around accidents can be exhausting for the whole family, and parents often worry about how these struggles affect their child’s confidence, self-esteem, and ability to join in with friends.

These conditions are common, but they are not normal, and help is available for children and their families.

Common causes of Youth Pelvic Health conditions

A number of things can contribute to a child’s bladder and bowel struggles, including:

• Constipation, which can involve hard, lumpy bowel movements, straining, pain, or a feeling of not fully emptying the bowels, and can also lead to stool leakage — constipation can contribute to bedwetting, since a large amount of stool in the rectum can push into the bladder and cause involuntary emptying
• Toilet avoidance — ignoring the urge to urinate or have a bowel movement over time can decrease the urge to go, worsen constipation, or lead to a thickened, smaller bladder wall that causes an overactive bladder, overflow incontinence, or difficulty fully emptying the bladder
• Tight pelvic floor muscles, which can make it difficult for a child to relax and coordinate these muscles, leading to leftover urine in the bladder and a higher risk of urinary tract infections or, over time, kidney issues
• Weak pelvic floor muscles, which may not resist the forces produced by running, jumping, laughing, or sneezing, allowing urine or stool to leak

Medical diagnoses for Youth Pelvic Health

When children over the age of 5 struggle to control urine or stool, they may be diagnosed with conditions such as:

• Bedwetting (nocturnal enuresis) — involuntary urination at night
• Daytime wetting (diurnal enuresis) — involuntary urination during the day
• Giggle incontinence — involuntary urination triggered by laughing
• Dysfunctional voiding — including voiding postponement or increased voiding frequency
• Constipation — difficulty passing bowel movements
• Fecal incontinence (encopresis) — involuntary leakage of stool

How we treat Youth Pelvic Health conditions

Child Pelvic Health Physiotherapy does not involve an internal exam, and a parent or guardian is always encouraged to be present during assessment and treatment. Our physiotherapists, with a background in both pelvic and orthopaedic physiotherapy, use a combination of:

• A thorough history, discussing your concerns and goals along with your child’s medical, family, and developmental history
• A physical examination, including external joint mobility, muscle length and strength, and, with consent, assessment of the external pelvic floor muscles using external biofeedback
• Education on pelvic anatomy and function, proper toileting positions and wiping habits, foods and drinks that may irritate the bladder or contribute to constipation, sleep patterns, and preventing toilet avoidance
• Manual therapy, including abdominal massage techniques to help develop the urge to void, along with work on the external joints and muscles that contribute to pelvic floor function
• Exercise therapy using external biofeedback and biofeedback games to teach children how to properly contract and relax their pelvic floor muscles
• Behaviour modification — such as a specific toileting schedule or changes to eating and drinking habits based on fluid, food, and bowel and bladder diaries — done in collaboration with your child’s broader healthcare team when needed, including family doctors, pediatricians, naturopathic doctors, occupational therapists, social workers, and psychologists

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