Back to school: A to Z with No problem with Pee!

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Fiona McMahon PT, DPT

It’s back to school time! Many of us look back at this time fondly. Reminiscing about the joy of picking out new notebooks, meeting new friends, and trying to put together a perfect back to school look (any 90’s kids remember the Delia*s catalog?) But if you are a kid or a parent dealing with a kid with urinary accidents, the idea of going back to school can be downright terrifying. In this blog, we will go through the causes of urinary incontinence as well as treatments. Here’s the thing, if you only have time to just skim this blog, I want you to know this: Urinary accidents are not your fault, nor your child’s and there are solutions out there to help improve accidents. So keep your and your kiddo’s heads up. It can get better.

In the spirit of back to school, we will start off this blog with some definitions. We can classify bladder accidents in many different ways, which can be helpful when it comes to selecting a course of treatment. Here are ways the medical community may classify your child’s incontinence

Intermittent versus Continuous: Intermittent applies to children who are having discrete individual episodes of incontinence, rather than continuous loss of urine from the bladder. The latter is more suggestive of neurological or anatomical impairment and does require a physician’s attention right away.

Intermittent incontinence can be further classified as primary or secondary. Primary incontinence occurs in children over 5 who have never achieved continence, whereas secondary incontinence occurs in kiddos who have had continence previously for a period of 6 months or more.

Urge Incontinence: Occurs when when a child has a sudden urge to urinate and cannot make it to the potty in time. It is a type of intermittent incontinence.

Stress Incontinence: Occurs when kiddos lose continence with activities like coughing, laughing, and sneezing. It is a type of intermittent incontinence.

Eneuresis or Nighttime Incontinence as the name would imply, this is intermittent urinary incontinence that occurs at night.

So here’s the thing, your child may experience just one type of incontinence or they may experience many types, (i.e. urge, stress, and bedwetting). Regardless of the type of incontinence your child is experiencing, they are not alone. Bedwetting is experienced in nearly 5%-10% of 7 year olds and daytime incontinence is experienced by 5-15 percent of kiddos between 5- 9 years old. It can be helpful to share this fact with your kiddo when they feel alone and isolated. Let them know that there may be several people in their class experiencing the exact same symptoms.

What Causes Incontinence in Kiddos?

In most kiddos, it is rarely one thing exclusively. One of the most common causes of incontinence at BBPT is constipation. The rectum and the bladder are neighbors sandwiched between two relatively immobile bones, the pubic bone in front and the sacrum in back. When a child, or an adult is constipated the rectum can become distended, like a big ol’ balloon. When the rectum is full of poo it squishes the poor little bladder leaving very little room for pee to collect before a child has to go. Furthermore, all that junk in the pelvic floor reduces the feeling that it’s time to go until it is much too late. Even a child that is pooping daily may be constipated. How can that be you may ask? Well, kiddos that are constipated may actually be incompletely evacuating resulting in a build up of stool in the abdomen. Signs besides bowel frequency that your child may be constipated include, abdominal pain, large painful bowel movements, itchy tushes, or even poo accidents. If you are still unsure, some doctors may do an abdominal x-ray to confirm the presence of large amounts of backed up poo in the abdomen

The pelvic floor is another huge player in urinary issues. The pelvic floor refers to the group of muscles between the pubic bone in front and the tailbone in the back. These muscles help regulate the flow of pee and poo out. Sometimes these muscles are too loose to hold everything in. Often times they actually may be too tight, which can lead to constipation, incomplete urination, and believe it or not, these muscles may also be too weak to hold in waste during play!

We see other factors linked to pediatric incontinence. Keep in mind these factors are correlated with incontinence and may not be necessarily causal. Kinda like a chicken and the egg situation. One may have caused the other or one may have no effect on the other. With correlations, it is often impossible to tell. Here are factors found in the research that have been linked with urinary incontinence in kiddos:

  • Younger age
  • Male sex
  • Black race
  • History of urinary tract infection (UTI)
  • Family history of bed wetting.
  • Difficult infant temperament
  • Early toilet training before 2 years
  • Late toilet training after 36 months
  • Attention-deficit Hyperactivity Disorder
  • Stressful life events

What to do About Pee Accidents

We have established that having urinary accidents as a child is pretty common. So the first thing to do, and I’m serious here, is remind yourself and your kiddo that you are not alone and that it is not your fault. Keep saying it until it sinks in. Potty issues can come with the extra burden of guilt and shame. Let it go. It is no longer serving you or your kiddo.

Now, it’s time to get the ball rolling. Although childhood incontinence has a 15% spontaneous cure rate every year after age 7, it leaves out a whopping 85% of kiddos who deserve being able to play and go to fun activities like sleepovers without fear of accidents.

First, get yourself a proactive doctor who will screen for UTI’s. They often don’t show up the same way in kiddos as they do for adults. UTIs can cause incontinence and left untreated, they can be dangerous.

Then get yourself to a qualified pelvic floor physical therapist who has experience working with kids. A qualified pelvic floor physical therapist has the ability to assess the muscles of the pelvic floor in a non-invasive manner to see if weakness or tightness could be a potential culprit. They also are qualified to assess the abdomen to determine if backed up poo from constipation is worsening accidents. Based on what they find, they will taylor a program to help fix any potential barriers your child could be facing on their way to continence.

Things to do now:

  1. Explore Irritants: Certain foods can irritate the bladder and cause accidents. Check out this list {HERE} to explore potential bladder irritants. Keep in mind, not everything irritates everyone. What I would suggest is a blander day followed by a day where you add back in a potential offender. Bladder irritants usually cause irritation within 2 hours, so if you don’t see anything in that timeframe, that item is most likely off the hook.
  2. Schedule the Potty: Kids are so scheduled these days but we need to add potty breaks to the agenda. Having your child attempt to urinate, whether she wants to or not can help. I suggest starting at once every hour during the day and gradually increasing the interval as they succeed. There are watches like the WOBL watch that can help kiddos out, but I also find teachers to be extremely helpful getting a kiddo to visit the bathroom regularly.
  3. Pee at the transition times: This one is from my clinical experience. Make sure your kiddo goes to the bathroom immediately before leaving camp or school. The on the way home accidents are usually the last to clear up . So nip it in the bud ahead of time.
  4. Drink water! But not to close to bed: Your child should be drinking enough water to keep his stool soft and his urine dilute. Dehydration can worsen bladder irritation and constipation, which can in turn worsen incontinence. Just stop water intake 2 hours before bed.
  5. Manage Constipation: Give your kiddo enough time to poo and make sure her diet is varied so her stools are formed but not pellets. If you struggle with this, come see us.

Wrapping it up:

One more time for the people in the back. You are working so hard. I never met a family who is not trying everything for their kiddo. Incontinence is tough, but with PT and support it can get better. If trying these steps is not working for you, come see us.

 

Check out Amy’s book Heal Pelvic Painwhich includes a chapter on the pediatric pelvic floor.

Baird D, Seehusen D, Bode D. Enuresis in children: a case based approach. American Family Physician. 90(8) 2015

Maternik M, Krzeminska K, Zurowska A. The management of childhood urinary incontinence. Pediatr Nephrol (2015) 30:41-50

Vasconcelos M, East P, Blanco et al. Early behavioral risks for childhood and adolescent daytime urinary incontinence and nocturnal enuresis. J Behav Pediatric. 2017; 38 (9): 736-42

Von Gontard A, Kutwertz-Bröking. The diagnosis and treatment of enuresis and functional daytime incontinence. Dtsch Arztebl Int 2019; 116 279-85

Ph101 Why is Pooping so Difficult?

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Fiona McMahon, DPT

The number of Americans who deal with constipation issues is massive (4 million!)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar  on  October 11th at 7pm.

Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating, and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast!  Light snacks and refreshments will be served.

Register at pelvichealth101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out or upcoming courses!

Pelvic Health 101 Fall 2017

 

PH101 Potty Issues with Kiddos

PottyFiona McMahon PT, DPT

Did you know kids can suffer from pelvic floor dysfunction too? Pelvic floor dysfunction in children can result in pain, bladder holding or constipation, embarrassing soiling accidents, frequent nighttime accidents, as well as trouble going potty. For most kids, there is an underlying physical component that needs to be addressed by an expert pediatric pelvic floor physical therapist.

It is very upsetting for a parent, guardian or caregiver to see a child suffer with pain or embarrassment, but there is so much that can be done to help out children with these issues. We use positive charts to develop short term and achievable goals to reinforce  behaviors and steps towards healthy toileting. Simple techniques like using the improving toilet posture, practicing deep breathing with bubbles, using a timer to assist in times voiding, educating the parent/guardian/caregiver on the colon massage, developing a core stability and stretching program, and more can go a long way towards improving bowel and bladder symptoms.

If your child is suffering from urinary or fecal accidents, bed wetting, skidmarks, or painful defecation, join me on May 11th, at 7pm , to discuss pelvic floor dysfunction in children, common conditions affecting pottying, and practical tips you can use to make potty time easier.

This is our last Pelvic Health 101 class of the spring series. We want to thank for an awesome season! Keep your eyes on the blog for the Fall’s PH101 classes!

RSVP: pelvichealth-101.eventbrite.com

Ph101 Why is pooping so difficult?

toiletFiona McMahon, DPT

The number of Americans who deal with constipation issues is massive (4 million!)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar  on  March 30th at 7pm. 

Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast!  Light snacks and refreshments will be served.

Register at pelvichealth-101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out or upcoming courses!

pelvic-health-101-spring-2017

PH101: Something’s Wrong with my What?

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Image via PlayBuzz

On March 16, 2017 at 7pm we will be kicking off our spring semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth-101.eventbrite.com

Here is our line up of this and future classes:

pelvic-health-101-spring-2017

PH101 Does my diet really matter?

Fiona McMahon, DPT

Gluten free, soy free, low FODMAP. It’s amazing how many diets there are out there that really can  provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results and have gotten really frustrated. If this is the case for you, I highly encourage you to come to our next pelvic health seminar on October 27th at 7pm, “Does my diet really matter”.

jessica-drummond-headshot-197x300This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar was a hit last year and is a great starting point for those considering adding nutrition as part of their healing journey.

 

 

 

Register at pelvichealth-101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall- (003)

Exercise, The Female Athlete, and the Pelvic Floor

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Fiona McMahon PT, DPT

In honor of National Women’s Health and Fitness Day ,September  28, we are exploring the benefits of regular exercise for women as well as addressing some pitfalls (pelvic floor included), that female athletes can fall into too. It is far too often that women find themselves sidelined from their favorite sports and fitness routines secondary to issues like orthopedic or sports-related pain or incontinence. Although all the issues outlined in this blog can occur to both genders, many of these conditions are more likely to happen to females, secondary to their pelvic structure and physiology.

 

Exercise and Its Benefits

heart-health

 

The benefits of exercise are too numerous to discuss every single one here and span the physical to the emotional. There are a number of conditions that have profound effects on the health of women nationwide. Let’s explore some of exercise’s specific benefits for these conditions together.

Heart Disease

According to the American Heart Association, Heart disease is the number one killer of women in the US and is responsible for 1 in 3 female deaths.  Exercise and a healthy lifestyle have been shown to reduce the risk of heart disease by 80%. The American Heart Association recommends 150 minutes of moderate activity or 75 minutes of vigorous activity to stave off heart disease.

Osteoporosis

Osteoporosis is unfortunately a common affliction among white and asian urban dwelling females.  It is characterized by reduced bone density, which causes bones to be fragile and increases the risk of fracture in individuals that have osteoporosis. Exercise has been shown to be helpful in both reducing the risk of osteoporosis as well as improving the bone mineral density of those who already have osteoporosis.

Other benefits of regular exercise include:

  • Reduced risk of diabetes
  • Reduced risk of colon cancer
  • Improved psychological well being
  • Maintenance of healthy body weight

Remember, it is important to consult with a trained healthcare professional before commencing a new fitness routine.

 

The Female Athlete Triad- Aka the Downside

All things in moderation. Although exercise is beneficial it is easy to over do it. It becomes easier to slip into an unhealthy relationship with exercise, especially in women who are training at elite levels, have eating disorders, or body dysmorphia issues.

The  female athlete triad consists of three disorders that can have severe health consequences in both the near and long term. The three disorders that compose the female athlete triad are:femaletriad

  1. Disordered Eating
  2. Ammenorrhea (absent periods or periods that are irregular)
  3. Osteoporosis

The female athlete triad is often attributed to the expectation that women keep a slender appearance. Girls and women who have body image issues may be at greater risk. The female athlete triad is dangerous and has the potential to be deadly. Osteoporosis can result  in fractures and eating disorders can seriously impact fertility, or even throw off the delicate balance of electrolytes in their system, putting them at serious risk for a cardiac event.

Warning signs of the female athlete triad include:

  • Yellowing of skin
  • Stress fractures
  • Rapid fluctuations in weight
  • Development of baby hair over skin
  • Daily vigorous exercise to an excessive level

 

The female athlete triad requires a multidisciplinary approach from medical, to psychological to nutrition.  It is important for someone who is suffering from the female athlete triad to seek help in order to safeguard their health and emotional well being.

 

Athletics and The Pelvic Floor

d14e2-tipsforahappyandhealthyvaginaLike any muscle, the pelvic floor can get fatigued, strained, or even go into a painful muscle spasm. The thing about the pelvic floor muscles, is that they have to work in almost every athletic pursuit. They work in partnership with the multifidus of the back, the transverse abdominus of the belly, and the diaphragm to stabilize and protect your spine. They also contract with every step during running activities to prevent your pelvic organs from dropping down in your pelvic cavity and to prevent urinary and or fecal leakage. Things can go wrong when the pelvic floor or other core muscles don’t function properly. Athletes’ pelvic floors can become tight and restricted, preventing closure of sphincters and support of pelvic organs. They may go into spasm from working too hard to stabilize the spine, if one of the other core muscles is failing to pull its weight.

Recently there has been more work to investigate the link between athletes and pelvic floor dysfunction. A recent study found that self identified female triathletes suffer from urinary and fecal incontinence at rates as high as 37.4% and 28.0%, respectively. Similar results were also found on a group of runners. Of the triathletes studied, nearly a quarter of them fit the criteria for female athlete triad, discussed earlier in this post.

Does this mean you have to give up your penchant for running? NO! (hellooooooo the author of this post is a runner), but if you find yourself experiencing incontinence, pain, constipation, and or painful sex, something is wrong and you must intervene in order to protect your long term health and your ability to participate in your favorite sport. At Beyond Basics Physical Therapy we combine orthopedic and pelvic expertise to help return athletes to their sports in a more functional and less painful condition. We relax tight muscles of the pelvic floor, train the core, including the pelvic floor if needed, to do its fair share, and return normal postural and structural alignment to our patients. We work one on one with you to develop a home exercise plan to help you reach your goals and prevent a reoccurrence of your pelvic floor or core disorder.

 

Please come see us so you can return to your sport in a better and more optimal condition than when you started: http://www.beyondbasicsphysicaltherapy.com/

 

 

Sources

American College of Sports Medicine. Information on … the female athlete triad. https://www.acsm.org/docs/brochures/the-female-athlete-triad.pdf. Accessed September 19, 2016

 

American Heart Association. Facts About Heart Disease in Women.  2016. https://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/. Accessed: September 6, 2016

 

Bø, K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine, 34(7), 451-464. 2004.

 

Illinois Department of Public Health: Women’s Health. Facts about  women’s wellness exercise . http://www.idph.state.il.us/about/womenshealth/factsheets/exer.htm Accessed: September 13 2016

 

Loyola University Health System. “Female triathletes at higher risk for pelvic floor disorders.” ScienceDaily. ScienceDaily, 23 August 2016. <www.sciencedaily.com/releases/2016/08/160823165743.htm>.

 

Stampfer M, Hu F, Manson J, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. The New England Journal of Medicine. 2000; 343(1). 16- 22
Todd J, Robinson R. Osteoporosis and exercise. Postgrad Med J. 2003; 79:320-23