MOTOR CONTROL IN PAEDIATRIC BLADDER AND BOWEL DYSFUNCTION
Siracusa C1, Bakker E2, Scandalcidi D3, Bower W4
1OhioHealth, Columbus, United States, 2HE L de Vinci, Research and Cntinuous Education, Brussels, Belgium, 3Physical Therapy Colsulting Specialists, Denver, United States, 4Melbourne Health, Melbourne, Australia
Learning objectives
- Evaluate paediatric bladder and bowel function and provide appropriate basic treatment recommendations.
- Recognize the role of physiotherapy in the management of paediatric BBD.
- Understand the association between paediatric BBD and associated symptoms in adulthood.
Description
This symposium will shed light on childhood bladder and bowel issues that may not be recognized by physiotherapists. Both the International Organization of Physical Therapists in Women's Health and International Organization of Paediatric Physical Therapists recognise that there is a gap in relevant education for physiotherapists that should be addressed.
The process of storage and emptying bladder and bowel requires perfect co-ordination of smooth- and striated muscles of the outflow region of the pelvis, including the pelvic floor muscles (PFM), and is regulated by complex neural control systems of the central nervous system. This can lead to symptoms as urinary and/or faecal incontinence, frequency, urge or reduced autonomy for bowel movements and recurrent urinary infection.
Automatic activation of PFM due to postural dysfunction, central sensitization of pain in the abdomen and others causes can disturb the process.
These BBD during childhood can often follow the patients into adulthood and develop into more complicated pelvic floor and motor control issues.
1.) Development of postural and pelvic floor muscles as the child develops overall gross motor function
2.) Genesis of dysfunctional voiding from urinary tract pathology and how pelvic floor muscle normalization fits into conservative management
3.) Genesis of bowel dysfunction and how it affects overall lower urinary tract dysfunction
4.) Behavioural retraining techniques, termed urotherapy in the literature, have an important place in the conservative treatment of these bladder/ bowel dysfunctions.
Physiotherapists need not specialize in pelvic floor physical therapy in order to educate children and parents on the practical solutions that will be introduced in this symposium. The presenters will focus on general case studies of children with bladder and /or bowel issues and provide the participants with easy behavioural and motor control treatment practices that can be integrated into any physiotherapy practice regardless of their speciality.
This symposium intends to shed some light on the scope of the childhood bowel and bladder issues that are not often recognized by physiotherapists. It will give practical solutions so that more children do not have to live with the stigma of poorly understood bladder dysfunction and decrease the cost of bladder dysfunction and missed school days for these children.
Implications / Conclusions
Bowel and bladder dysfunction does not affect just children with neurological and developmental issues. It can also affect the typically developing child and can cause issues well into adulthood. Often those treating adult pelvic floor issues are not aware that these problems began in childhood. It is important for physiotherapists to evaluate childhood bladder /bowel and motor control issues in their history in order to get a global view of the patient. There are also a variety of behavioural interventions that paediatric physical therapists can implement immediately that can have an impact on the child's quality of life.
Keywords
- pelvic floor
- pediatrics
- bowel/bladder
Funding acknowledgements
Not applicable
Relevance to physical therapy globally
Bowel and bladder dysfunction ( BBD) is a common issue in both typically developing children and those with neurologic dysfunction. It can lead to day/night time urinary, fecal incontinence, overactive bladder, dysuria and constipation. At age 10-14 years 10% of healthy schoolchildren report a form of incontinence. According to the Rome III criteria, constipation has a prevalence between 0.7-29.6%. Conservative treatment by physiotherapists is recognised as first-line treatment for those children by the ICCS.
Target audience
Pelvic floor and paediatric physiotherapists, and any other physiotherapists with an interest in bowel and bladder function and its relationship to motor control
Programme subject to change
