Pediatric Pelvic Health

Typically, children are toilet trained by age 4. After age 4, bowel and bladder dysfunction should be addressed by a team of medical professionals. When the pelvic floor muscles are not working together with the bladder and/or bowel, the normal voiding reflexes can be disrupted. Dysfunctional elimination habits can lead to chronic abnormal patterns resulting in leaking and constipation.

How can Physical Therapy help my child?

Through innovative and child-friendly treatment techniques, the physical therapists at CorePhysio will work with your child to help improve their bladder and bowel control.

Typical symptoms of dysfunctional elimination include:

  • Bedwetting (nocturnal enuresis)
  • Constipation
  • Fecal soiling or smearing
  • Urinary and fecal incontinence (leakage)
  • Urinary urgency, frequency and retention

Tips for Successful Toileting

  • Avoid start/stop flow during urination.

  • Avoid forcing the urine flow.

  • Urination should take up to 10-12 seconds. A counting game can be helpful and fun when learning to slow the urine flow.

  • Keep books near the toilet to allow longer toileting time.

  • Ensure the toilet is safe, comfortable, and private. A stool to support the feet will allow a secure and relaxed toileting experience.

  • Encourage 4-6 glasses of non-caffeinated, non-carbonated fluid per day.

  • Fluid intake should be restricted 2 hours before bedtime.

  • For easy access with nighttime toileting, place nightlights in the bedroom, hallway, and bathroom.

  • Quiet playtime 1 hour before bedtime will help bladder muscles to relax.

  • Empty the bladder just before bedtime.

  • Treat constipation and encourage immediate toileting when the child has the urge to defecate.

  • Avoid holding his/her breath when defecating. Blowing a windmill or whistle can help avoid holding the breath.

© Michigan Medical, P.C. Physical Therapy, 4069 Lake Drive SE, Suite 114, Grand Rapids, MI 49546, Phone: (616) 726-8365


If your child has a history of constipation or has recently become constipated, discuss your child’s changes in bowel habits with your physician. Many people require more bulk in their diet in the form of high fibers, fiber additives, or other bulking agents sold at drug stores. You should discuss your child’s fiber needs with your physician, pharmacist, or nutritionist. When adding fiber to your diet it is important to remember to encourage your child to drink plenty of fluids. Adding a laxative to your child’s regimen should also be discussed with your physician.

Constipation is when it’s difficult to have a bowel movement or when bowel movements don’t happen often enough. Your child should have between 3-7 bowel movements per week. If your child doesn’t, it may be because of many different dietary factors, including:

  • Not drinking enough water (4-6 cups needed per day)
  • Eating too much high fat and high sugar content foods
  • Not eating enough fruit or vegetables (5 servings needed per day)
  • Not getting enough physical activity (although there is not a specific standard for the number of minutes a young child, ages 2-5, should play, physical activity should be encouraged several times per day. Children and adolescents (6-17 years old) should do 60 minutes or more daily, with the majority being moderate to vigorous activity, like biking, running, and climbing.

Constipation can also cause bladder problems. A bowel that is full of stool may irritate the bladder, which can cause urinary leakage, urgency, and/or frequency.

© Progressive Therapeutics, PC and