Understanding Pediatric Pelvic Floor Physical Therapy: A Guide for Parents

When people hear “pelvic floor physical therapy,” they often associate it with postpartum care or adult continence issues. However, children can also experience pelvic floor dysfunction, which can significantly impact their quality of life. Pediatric pelvic floor physical therapy is a gentle, child-centered approach to treating bladder and bowel concerns—conditions that are far more common than many realize. 

Children with pelvic floor dysfunction may experience a variety of symptoms that can be frustrating for both them and their families. Some of the most frequent urinary symptoms include: 

• Urinary frequency (needing to urinate often) 

• Daytime accidents 

• Bedwetting 

• Straining to void 

• Frequent urinary tract infections (UTIs) 

On the bowel side, children may suffer from: 

• Infrequent bowel movements (fewer than 3 times per week) 

• Hard or painful stools 

• Encopresis (fecal incontinence due to chronic constipation) 

• Avoidance of bowel movements due to fear or pain 

Parents might also observe holding behaviors, where children actively try to delay voiding or bowel movements. These can look like leg crossing, sitting on the heel, pressing a hand to the perineum, or other subtle postures. These behaviors signal that a child is suppressing the urge to go—often contributing to worsening symptoms over time. 

Early identification is key to effective treatment. Simple screening questions can help determine whether a child might benefit from pelvic floor physical therapy: 

Does your child urinate fewer than 4 times per day? 

Is your child still leaking urine overnight past age 5? 

Does your child have bowel movements fewer than 3 times per week? 

Does your child strain to poop or urinate? 

Answering “yes” to any of these could indicate an underlying dysfunction in pelvic floor coordination or core muscle development. 

Pediatric pelvic floor physical therapists use a variety of tools and techniques to help children retrain their bodies for more efficient bladder and bowel function. Treatment often includes: 

1. Rehabilitative Ultrasound Imaging 

Rehabilitative ultrasound is a non-invasive, child-friendly way to visually assess the function of the pelvic floor muscles, diaphragm, and abdominal wall. It allows the therapist to show children and parents how muscles are (or aren’t) engaging during specific movements or when trying to void. This visual feedback helps children learn to properly coordinate their pelvic floor muscles—an essential step toward better bladder and bowel control. 

2. Biofeedback 

Biofeedback uses sensors placed on the skin to measure muscle activity. Children can see their pelvic floor muscle activity in real time on a screen, learning how to contract and relax these muscles appropriately. This interactive treatment makes it easier for children to understand how their body works and gives them a sense of control over their symptoms. 

Children with pelvic floor dysfunction often have poor coordination between their diaphragm, abdominal wall, and pelvic floor muscles. These three areas work as a team to maintain intra-abdominal pressure and support healthy elimination. 

When this coordination breaks down, a child may experience: 

Increased rib flare (the lower ribs stick out) 

Increased lumbar lordosis (an exaggerated curve in the lower back) 

Protruding abdomen 

Weak core strength 

These postural and muscular imbalances can lead to poor pressure management during voiding or bowel movements, making it harder to fully empty the bladder or bowels—and increasing the risk of urinary leakage or constipation. 

Pelvic floor physical therapy includes exercises and activities that target this coordination. Children learn breathing techniques that enhance diaphragm excursion (the movement of the diaphragm during breathing), as well as core strengthening exercises that support better posture and pressure regulation. 

Therapy also includes education and habit training. Many children with pelvic floor issues don’t drink enough water, eat low-fiber diets, or avoid going to the bathroom due to anxiety or discomfort. These factors all contribute to the problem. 

Key behavioral and dietary recommendations often include: 

Increase water intake: Staying hydrated softens stools and helps the bladder function optimally. 

Add dietary fiber: More fruits, vegetables, and whole grains can promote regular, comfortable bowel movements. 

Establish a bathroom schedule: Encourage children to sit on the toilet at regular intervals—especially after meals and before bedtime—even if they don’t feel the urge. 

Sitting correctly on the toilet is also emphasized. Therapists often use footstools to help children maintain a squatting position, which is more anatomically favorable for both urination and defecation. 

Children struggling with bladder or bowel issues may experience embarrassment, anxiety, or even bullying. They may avoid sleepovers, school trips, or social events. Pelvic floor physical therapists work closely with families to create a supportive, shame-free environment where kids can feel comfortable and empowered. 

Collaboration with other professionals—such as pediatricians, gastroenterologists, dietitians, or psychologists—may also be needed for a more comprehensive treatment approach. 

If your child shows signs of bladder or bowel dysfunction, don’t wait. These issues often do not resolve on their own and can persist into adolescence and adulthood if untreated. Pelvic floor physical therapy offers a safe, non-invasive, and often highly effective solution for restoring healthy bathroom habits and confidence. 

Pediatric pelvic floor physical therapy is more than just muscle training—it’s about re-establishing proper coordination between systems, building healthy habits, and improving a child’s confidence and comfort in daily life. By addressing the root causes of symptoms like urinary accidents, constipation, and holding behaviors, pelvic floor therapy helps children—and their families—regain control and peace of mind. 

If you suspect your child may benefit from pelvic floor physical therapy, talk to your pediatrician or reach out to a trained pelvic health therapist. Early intervention can make a world of difference. Click HERE to schedule now! We offer a free 15 mintue phone consultation to help answer questions and make sure you are in the right place for healing.

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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.