Pelvic floor basics, kid version

The pelvic floor is a group of muscles that must relax and coordinate during a bowel movement. Some kids keep these muscles tight without realizing it. That can look like pushing harder with no success, straining, or stool withholding even when stool is soft.

Map: signs of coordination trouble

• Stool is soft but still hard to pass.
• Long sits with straining and little output.
• Frequent urge but incomplete emptying.
• Belly pain that improves after bowel movement but returns quickly.

Tune: posture plus breath, the fastest win

Posture

• Feet supported. Knees above hips.
• Lean forward slightly.
• Relax shoulders and jaw.

Breath cue: the long exhale

Teach the child to exhale slowly like blowing bubbles or cooling soup. The long exhale supports pelvic floor release and reduces straining.

Weave: three kid friendly skills

1. Bubble exhale: blow bubbles for five slow breaths while sitting.
2. Heavy feet: press feet into the stool and relax the belly.
3. Jaw soft: unclench teeth, tongue rests on the floor of the mouth.

When therapy is worth it

Pelvic physiotherapy and biofeedback are used for pelvic floor dyssynergia in constipation. Studies in adults and some pediatric work suggest that targeted training can be helpful when coordination is the limiting factor. Ask a pediatric gastroenterology team or pelvic health physiotherapist about evaluation and whether training is appropriate for your child.

Biofeedback trial for pelvic floor dyssynergia (Heymen 2009)

Pelvic physiotherapy in children with functional constipation (van Engelenburg van Lonkhuyzen 2017)

MTWM creative strategy: the Elevator

Many kids push down harder when they are stuck. That increases tension. Use an "Elevator" image instead.

• Ask the child to imagine an elevator going down slowly on the exhale.
• On the inhale, the elevator pauses. No pushing.
• Do five elevator breaths. Then stand up and move if frustration rises.

References

• Heymen S et al. Randomized trial of biofeedback for pelvic floor dyssynergia. 2009.
• van Engelenburg van Lonkhuyzen M et al. Pelvic physiotherapy in children with functional constipation. 2017.