Category Archives: Pediatric Pelvic Floor

Potty Yoga

As many of you know, I am very nerdy–in a great way, I believe. And this nerdiness especially comes out when you take a look at my leisure reading material. Recently, I began reading a new book that came to me in a package of promotional materials from the awesome website, Potty MD. Potty MD offers excellent products and books–including my reading of choice, Overcoming Bladder & Bowel Problems in Children by Dr. D. Preston Smith. This $8 book is a jewel and is full of great recommendations–including an appendix full of kid-friendly fiber recipes! I have loved reading it, and I especially loved his idea of practicing “Potty Yoga.”

Now, for those of you who have done yoga in the past, I’m sure you are wondering how the two words “Potty” and “Yoga” can possibly be paired together. But actually, I think the ideas work very well and that both children and adults can truly benefit from the idea of “Potty Yoga.”

Spending time on the toilet is something both children and adults often tend to avoid. We feed into this mindset for ourselves, even referring to bathroom stops as “Pit Stops” comparing our urination to that of a racecar stopping mid-course. The unfortunate side effect of this is that many adults develop poor voiding patterns with bad habits and our children develop frequent urinary tract infections and experience accidents.

Normal emptying of the bladder occurs with a coordinated relaxation of the pelvic floor muscles and a contraction of the detrusor muscle of the bladder to empty urine. This actually involves very little work on our part. Our job is simply to breathe and relax and allow our bladder to empty itself. When we try to speed up this process by pushing or straining, we often negatively impact the bladders function and can develop dysfunctional voiding patterns, difficulty emptying our bladder and pelvic floor muscle incoordination.

For children, dysfunctional voiding patterns often develop from chronically trying to hold urine for longer periods of time. Often times children become involved in playing and do not wish to stop their activities to use the potty. Abnormal habits can often make it more difficult to start a urine stream, which can cause a child to become frustrated and cause unnecessary straining/pushing to empty. Often children are also thinking of other things on the toilet which worsens the difficulty in emptying.

Parents can feed into this process without meaning to by urging the child to “hurry up” or distracting the child by games/playing on the toilet. This unfortunately only makes it more difficult for the child to relax his/her muscles to properly allow the bladder to empty.

Instead, both adults and children should practice, “Potty Yoga.” Yoga focuses on mindfulness, allowing the mind to stay on task, breathing and allowing the body to fully relax. Children and adults should use proper posturing on the toilet as well to allow muscles to fully relax, and should spend 2-3 minutes uninterrupted in order to get positive results. Dr. Smith encourages children to sit in a relaxed position, quiet and comfortable, with eyes closed and slow breathing to avoid being distracted and to allow focus to stay on the bladder.

This same habit should be used for bowel movements to allow muscles to relax and improve ability to empty. So, take a deep breath and get into the habit of practicing potty yoga. The results for your body could be wonderful.

Namaste!

Written by Jessica Powley Reale, PT, DPT, WCS

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4 Children’s Books to Improve Your Child’s Bathroom Habits

As you know from my previous post, we are SUPER excited to be rolling out our Pediatric Pelvic Floor Program. With that being said, my next few posts are going to cater to this specific population–with this first being an introduction to a few books that I think are awesome for helping kids with bladder and/or bowel problems.

First, let me say that I LOVE children’s books. I love the photos, the stories, the fantasy–I have many wonderful memories of my mother and father reading classics like Goodnight, moon!, The Rainbow Fish, and  Alexander and the Terrible, Horrible, No Good, Very Bad Day. Maybe that’s why I loved seeing all of the children’s books specifically written to help kids with bathroom health. Regardless, here we go– 4 books to improve your child’s bathroom habits (in absolutely no particular order).

1.) Everyone Poops by Taro Gomi

Everyone Poops

What child doesn’t love a book with the word “poop” in the title? Everyone Poops is perfect for the child who is embarrassed of having to have a bowel movement. Although embarrassment may not seem like a big deal initially, it is important to recognize that for some children, embarrassment could be the start of a pretty big problem. Often children who are embarrassed to have a bowel movement will develop chronic holding patterns which can create painful hard stool, bowel leakage, and difficulty having bowel movements. I love Everyone Poops because it’s funny, fun, and normalizes having a bowel movement to take away the fear. Plus, it only costs $4.99 on Amazon.com–who can say no to that?

2. Look Inside: Your Body (Usborne Look Inside)

Look Inside

Ok, I will be honest with you– this may have recently become my most favorite children’s book ever! How could it not be? It literally has over 100 flaps to open inside! When this arrived to my clinic I forced my poor student to listen to all of the fun little facts under each flap in this book. It is filled to the brim with excellent information on the body and even has a beautiful 2-page spread on the digestive system. Plus, it’s interactive–your child can lift a flap and see how the bicep muscle works…lift another flap and see how our ears hear!  My only beef is that they really did not include much information on Urinary function…but other than that, it is amazing! It may have just become my book I give all of my pregnant friends for their new kiddos. Amazon.com $10.48 and worth every penny!

3. It Hurts When I Poop: a Story for Children Who Are Scared to Use the Potty, by Howard J. Bennett

Hurts to Poop

Back to the poop– Constipation is the worst! And fear related to using the bathroom can be equally as bad as embarrassment in creating holding patterns and constipation in children. This book was written by a physician who provides a relatable story for children fearful of using the bathroom. The story follows a young boy Ryan as he goes to see a doctor to help with his constipation. Dr. Bennett also does a great job at providing great recommendations for kids and parents to help improve bowel function! I especially love his page on “foods that make poop hard” and “foods that make poop soft.” This book is an absolute must for children dealing with constipation. The reviews on Amazon.com really say it all, and this book only costs $8.96.

4. Sammy the Elephant and Mr. Camel: a Story to Help Children Overcome Bedwetting, by Joyce Mills and Richard Crowley

Sammy and Camel

How could you not love the sweet story of an elephant who struggles with carrying water, is mentored by a camel, and goes on to save the town by putting out a fire? This wonderful story not only provides a powerful image for children having difficulty with enuresis (bedwetting), but it also is great for improving self-esteem in children and decreasing feelings of guilt or low self-worth. This book also includes information in the back for helping parents take the next steps to improve a child’s bladder function. An excellent read for kids and parents alike! And only $8.96 on Amazon.com!

I hope you will consider picking up some books if your child is having bowel or bladder problems! Do you have any other great books for this? Let us know in the comments!

By Jessica Powley Reale, PT, DPT, WCS

Introducing Pelvic Floor Physical Therapy for Children!

Pediatric

We are pleased to announce that we will now be offering pelvic floor physical therapy for children in the Upstate area of South Carolina. We are very excited about this new offering and have worked hard over the past few months preparing our clinic space to accommodate children. Our PTs have also attended advanced training through Herman & Wallace Pelvic Rehabilitation Institute to learn about to apply our knowledge of treating adults with PFD to children! Our PTs are trained in working with children experiencing:

  • Urinary incontinence (loss of urine)
  • Enuresis (Night-time incontinence)
  • Urinary urgency and frequency
  • Urinary retention or voiding dysfunction (difficulty emptying)
  • Constipation (including pain with and/or difficulty emptying bowels)
  • Diarrhea (with and without leaking)
  • Constipation with fecal soiling
  • Chronic abdominal pain

We recognize that working with children requires unique considerations, and we strive to provide a comfortable setting where children and their parents can work together with their physical therapist to address their concerns. Our goal is to make Pelvic PT fun and interactive for children, and we use games, books, and prizes to help create the perfect environment for children to reach their goals.

Our physical therapy plans often will include:

  • Thorough evaluation of medical history, diet, sleeping patterns, etc.
  • Assessment of the hip and low back musculoskeletal structures
  • Visual (non-invasive) assessment of the pelvic floor muscles
  • Animated EMG biofeedback training
  • Extensive behavioral and dietary training
  • Appropriate stretching and strengthening as indicated
  • Specific individualized home program

Please feel free to contact our office at (864) 454 – 0952 with any particular concerns or questions. Pelvic Floor PTs treating children are located at our Patewood, Simpsonville, Greer and Spartanburg locations. Referrals can be faxed to (864) 454-0925.

Are you thirsty for more? Check out this post I wrote a year ago on tips for improving bathroom function in children!

Written by: Jessica Powley Reale PT, DPT, WCS

“Do you need to go potty?” 5 Tips to Improve Your Kiddo’s Bathroom Health

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“You don’t understand! I’ve been constipated since I was a kid–it runs in my family!” 

I can’t tell you how many times I have heard that statement! We constantly reiterate on this blog that bowel dysfunction is never normal–common, yes–but not normal! And this is true for any situation, whether a person is 5 years old or 85 years old. Recently, I’ve been thinking about that same above statement and a light bulb went off,

“What if we were to change poor bathroom habits into good bathroom habits from an early age?” 

Would that help reduce the number of people who need my help when they’re older? I can’t help but think it would! So, today’s post is for you Moms and Dads! Strive to build healthy, good bathroom habits for your kids to decrease problems both now and later on!

Here are your 5 tips to do just that!

1. Encourage adequate fluid intake (mostly water!) and fiber intake

The average person should consume 5-8 8-oz cups of fluid per day–and your child is no different! Fluid is SO important for both the bladder and the bowels! For the bladder, having adequate fluid decreases the risk of urinary tract infections, encourages normal bladder urges, and allows for a normal light colored urine instead of a dark concentrated urine. As an aside, taking in too many sweet sugary drinks, caffeinated drinks, and carbonated drinks will actually irritate the bladder and could make your child go to the restroom more frequently as well as put your child at risk for problems with the bladder later on in life! (Note: Remember this if your child has difficulty with bed wetting!). For the bowels, adequate fluid allows for a soft stool that is easy to pass! If your child is not getting enough water, he or she will likely have a  more firm stool as the intestines have worked to absorb the fluid your child needs for normal bodily functions. Many a patient has been “cured” of constipation simply by drinking more fluid!

Fiber is also very important to encourage a good bowel consistency. Aim for 20-30 grams of fiber per day! Good fiber sources include fresh fruits and vegetables, whole grains, oatmeal, granola, seeds and nuts! For good recipes for your kids, check out Gina’s recipes from Skinnytaste.com that are “Kid Friendly” here.

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2. Encourage your child to listen to his or her normal body urges

This goes for both the bladder and the bowels as well! Quick lesson on anatomy and physiology–We have a normal reflex in our colon that helps us hold our stool to empty at an appropriate time (Yay!). Unfortunately, if a person holds stool for too long, the normal colon response to help us poop is dampened–meaning it won’t work as well! For the bladder, over suppressing bladder urges can cause a similar issue; however, your child could also develop some problems from going too often without an urge–Yes, I’m talking to you, “Just-in-case Mom.” A bladder that empties often without an appropriate urge can begin to give urges at inappropriate times. So, go when you need to go. Don’t go when you don’t!

3. Get your kids moving! 

I’m sure you’ve heard it in the news these days that kids need to get moving more! But, to take a new spin on it, encouraging your kids to move more will actually help keep their bowels more regular! Yes, it’s true, exercise is a stimulant to the bowels. So, encourage your kids to get outside and play, ride their bikes, do family walks and games– the more your kids move the better!

4. Help your child develop a bowel routine 

This one ties in perfectly with our last point. Here’s the scenario:

“8 year old Mary is not a morning person. Mom has a hard enough time getting Mary out the door in the morning, and this often means eating a bagel on the way to school. After Mary gets to school, she often needs to go #2, but is too embarrassed to go and holds it the whole day.”

Unfortunately, kids like Mary usually develop constipation from over suppressing those urges! This can be helped by building a routine for your kids in the morning (or evening) to help encourage a normal bowel movement.  We know that the colon LOVES consistency, so try to encourage your kids to spend some time on the toilet at the same time each day. We also know that the colon loves fluid (hot especially), hot food, and exercise! So, a good bowel routine would look like this:

“To help Mary’s bathroom habits, Mom started waking Mary up 30 minutes earlier. Mary starts her day with a warm bowl of oatmeal, then plays with her pet dog.  After they play, Mary heads straight to the bathroom to have a BM.”

Yes, building a routine takes some extra time–but it is well worth it to prevent constipation in your kiddos!

5. Encourage proper toilet positioning

Yes, there is a right way to sit on the toilet. For children, most toilets are too tall and this makes it difficult for them to relax the muscles around the anal canal to help them poop without pushing hard. Kids will compensate by straining, but over time this can be very detrimental to their pelvic health. To help them out, get a small stool to go in front of your toilet seat which will help encourage them to fully relax their muscles. Encourage them to lean forward and relax on their knees. This will help straighten out the rectum to encourage easy emptying.

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Then, and most importantly, make sure they have time. Encourage them to read a book or magazine and give their colon 5 uninterrupted minutes to “do its thing.” If they feel like they need to push, encourage them to breathe while they push to avoid the typical valsalva maneuver we often see. Learning this will help them so much both now and in the future! For more information, read this excellent post from my colleague, Jenna Sires, called “Are you Pooping Properly?

What have you tried to help encourage good bathroom habits for your kids? Feel free to comment below! Here’s to a healthy upcoming generation!

Written by: Jessica Powley, PT, DPT, WCS

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