In Control Physical Therapy - FREQUENTLY ASKED QUESTIONS

Our doctor says our child has Encopresis, now what?
Consultations regarding history of the condition, contributing factors of lifestyle, and any other medical issues, need to be discussed. This is followed by a physical examination of the child, looking at overall posture, range of motion and muscle tone, with specific focus on pelvic floor muscle function and coordination. No internal examinations are performed. From here, treatment and timeline for resolution can be discussed. Untreated, this condition can persist for many years.

Why is my child soiling his/her pants?
There can be several reasons for soiling. Sometimes children lose their ability to hold their stool following long bouts of constipation. The internal anal sphincter can fail, leaving only the small external one to hold, which can eventually fail as well, causing the leakage.  Sometimes it can be a sensory issue, where the nerves in the perianal area are desensitized and no longer can “feel” the feces as it leaks out. There are several reasons that soiling may occur. It is important to understand that many times, this is not a behavioral issue, but a physical one. There may have been initial behaviors, or new behaviors that were or are now, contributing to the problem, and it can be difficult to determine which is the cause. Regardless, a physical component has likely developed, that needs to be addressed  before things will get better.

Why is my child holding his/her stools?
Holding can result from fear of pain with the bowel movement, the need for increased pressure inside the abdomen (this is not something the child decides, but is reflexive in nature), or the lack of the sensation of the voiding signal. There are treatment opportunities for these issues as well as others that may be causing your child to hold their bowel movements.

Why is my child still wetting the bed?
There are several reasons for outside age appropriate bed wetting. Many times, there is an imbalance in the hydration system of the body, or of appropriate voiding during the day, leading to over flow at night. Constipation and diet can also play a part.

Our doctor says our child has enuresis, now what?
Multiple factors can be the cause of daytime urine leakage. Stress incontinence (pelvic floor weakness with laughing, jumping or playing) can contribute to this issue. Many times diet irritants and frequent UTI’s impact the ability for the child to tell if they need to void. Over or under awareness of body signals can also play a part. Constipation and voiding volumes are also considerations. This issue is multifactorial and needs to be addressed from multiple angles for resolution to occur.

Why is my child peeing his/her pants?
Multiple factors can be contributing to this condition. This condition is called enuresis, but may be urination of full voids, not just leaking. Episodes of this are normal for children up to 7. But these episodes are infrequent (once in a while-1 time in 1-2 months). If your child experiences this on a regular basis, then there can be something that needs to be addressed, which will help decrease or eliminate this problem.

Why is my child holding or having a challenging time going pee?
Sometimes children appear “too busy” to use the bathroom, and when they go, they go through the voiding process extremely fast. Some children do not want to leave what they are doing, and will hold so that they don’t “miss” something. Some hold due to the inability to recognize body signals or have been in the holding pattern so long, that the signals are weak to nonexistent, until the body’s need to void becomes urgent. Muscle tone and range of motion of the pelvic floor can be so restricted, that the bladder is not able to fully empty.   There can be other factors that influence this condition.

Regardless of the condition, an evaluation can help figure out the root cause, and determine the best course of action.

SIGNS AND SYMPTOMS 

Your child may need physical therapy treatment if:

• They have had a significant change in continence: Completely continent up until recently when incontinence began and continues to be an issue

 

• Have been cleared by family physician, specialist MD such as GI or urologist, for any medical issue and continue to have issues with fecal/urine leakage

 

• Have long standing bed wetting issues where medicines didn’t help

 

• Have pelvic or low back pain which may or may not be associated with incontinence

• Migraine headaches not relieved by medication

• Have had pelvic floor trauma

• Leak or are damp with after sporting practices or events

• Have been told you have “dysfunctional voiding” and do not qualify to see a urologist

• Your child is over the age of 7 and has been told that they will “grow out of it.”

WARNING:

DO NOT USE THE INFORMATION ON THIS WEBSITE WITHOUT FIRST RECEIVING AN EVALUATION FROM A PHYSICAL THERAPIST AND THEN FOLLOWING THE THERAPIST’S TREATMENT PLAN.  The purpose of the information presented on this website is to educate users about our services.  The information presented is NOT a substitute for those services.  A full evaluation by a medical professional is required to determine the proper treatment plan in every case.

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