Supporting Little Bodies: Understanding Pediatric Pelvic Floor Dysfunction and How Rehabilitative Ultrasound Imaging Can Help

Pediatric pelvic floor dysfunction is more common than many realize. Conditions like urinary incontinence, bowel accidents, and retention can significantly impact a child’s confidence, emotional well-being, and family life. Often, these issues are not due to behavioral concerns but are rooted in muscle coordination, tone, and core stability challenges. Fortunately, rehabilitation techniques are evolving—one of the most effective, child-friendly tools available today is rehabilitation ultrasound imaging (RUSI). 

This non-invasive, real-time imaging method allows pelvic health therapists to visualize how a child’s pelvic floor and core muscles function during movement and play. It opens up new pathways for understanding and treating conditions like bladder leaking, fecal retention, giggle incontinence, and poor pelvic coordination—without invasive exams. 

The pelvic floor is a group of muscles that supports the bladder, bowel, and pelvic organs. In children, this muscle group can become dysfunctional in several ways: 

1. Bowel and Bladder Accidents 

Children may experience stool or urine leakage due to poor pelvic floor control or constipation-related overflow incontinence. 

2. Withholding Behaviors 

Some children chronically withhold urine or stool, often leading to: 

• Constipation 

• Urinary tract infections 

• Bladder retention and overstretching 

3. Bladder Retention 

A child may appear to urinate infrequently or show signs of discomfort before urinating, due to: 

• Pelvic floor muscles failing to relax 

• Inability to sense bladder fullness 

• Poor coordination with abdominal muscles 

4. Giggle Incontinence 

In this condition, the child involuntarily empties their bladder when laughing. Though once thought neurological, many cases are related to poor pelvic floor reflex control and postural issues. 

Rehabilitation ultrasound imaging (RUSI) allows clinicians to observe deep core and pelvic floor muscle activity in real time without invasive tests. A small probe placed over the lower abdomen or perineal area sends real-time images to a monitor. Children (and parents) can see what their body is doing—helping children and parents to better understand what is going on in their bodies.  The RUSI can help to visualize: 

• Movement and activation of the pelvic floor muscles 

• The transversus abdominis (deep core muscle) and its relationship to pelvic floor function 

• Bladder filling and emptying patterns 

• Muscle coordination during breathing, squatting, coughing, or giggling 

• Straining or bearing down with practicing to poop or pee 

Because it’s non-invasive, ultrasound is ideal for pediatric patients who may be anxious or shy about medical procedures. 

By watching the pelvic floor on ultrasound, therapists can identify two major dysfunction patterns: 

1. Decreased Core Strength with Poor Pelvic Control 

Children with low tone or delayed motor development may struggle with: 

• Poor co-contraction of core and pelvic floor muscles 

• Inability to maintain pelvic stability during play or postural tasks 

• Weak pelvic floor muscles with minimal active lift or closure during movement 

These children are often floppy in posture, tire quickly, and may slouch during sitting. They may also experience frequent accidents due to underactive muscles. 

2. High Tone with Poor Relaxation and Elongation 

On the flip side, some children hold excessive tension in the pelvic floor and deep abdominal muscles. On ultrasound, this appears as: 

• Constant contraction of the pelvic floor, even at rest 

• No visible downward motion or lengthening when instructed to relax 

• Uncoordinated muscle activation patterns 

These children may suffer from retention, constipation, bowel overflow leaking, urinary leaking with activities, or incomplete urination, as the muscles never fully “let go.” 

Pediatric pelvic floor therapy isn’t just about Kegels or sitting on therapy balls. Treatment is play-based, functional, and developmentally informed. Once dysfunction patterns are identified, therapists use movement to retrain the pelvic floor and core through positions that mimic early motor milestones. 

1. Squatting 

• Encourages pelvic floor lengthening and relaxation 

• Promotes natural bearing down for bowel movements 

• Helps children with tight or hypertonic pelvic floors feel safe “letting go” 

2. Tall Kneeling and Half Kneeling 

• Enhances core and hip stability 

• Creates awareness of pelvic alignment 

• Great for strengthening the transversus abdominis and gluteal muscles, which support pelvic control 

3. Standing on One Leg 

• Challenges balance and pelvic stability 

• Highlights asymmetries or compensations 

• Encourages co-activation of pelvic and core muscles during functional activities like walking or climbing stairs 

4. Blowing, Laughing, or Breathing Drills 

• Helps children coordinate pelvic floor activation during pressure changes (e.g., giggling or coughing) 

• Pairing RUSI with these tasks gives visual feedback for retraining reflexive control 

These activities are often disguised as games, obstacle courses, or role-play—keeping therapy child-friendly and effective. 

Children with pelvic floor dysfunction often exhibit global movement delays or motor planning issues. A weak core leads to: 

• Poor posture in sitting or standing 

• Increased pressure on the pelvic floor muscles to “compensate” 

• Difficulties with toilet posture and breath control 

By using RUSI to teach correct core-pelvic floor synergy, children build stronger motor patterns that support continence and confidence. 

One of the most powerful aspects of rehabilitation ultrasound is that it includes the child in their own healing process. Kids can see their muscles working (or not), make changes in real-time, and gain confidence in their bodies. It also allows therapists to educate parents on what’s happening inside, validating concerns and providing tangible goals. 

Rehabilitation ultrasound is revolutionizing pediatric pelvic floor therapy by offering: 

• Non-invasive insight into complex pelvic and core dysfunctions 

• Real-time feedback to improve muscle control 

• Visualization of progress over time 

• A playful, developmentally appropriate way to engage children in their therapy 

When combined with movement-based treatments like squatting, kneeling, and postural play, ultrasound becomes a powerful tool to restore function and self-esteem in kids who struggle with pelvic floor challenges. 

If your child is struggling with potty accidents, withholding, or giggle incontinence, don’t assume they’ll “just grow out of it.” These are treatable conditions—and pelvic floor physical therapy with rehabilitation ultrasound offers a compassionate, science-backed, kid-friendly approach. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.