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Pediatric Incontinence and Pelvic Floor Dysfunction

Herman & Wallace Pelvic Rehabilitation Institute

Objectives

Upon completion of this continuing education seminar, participants will learn:
List 2 muscles groups and describe 3 functions of the pelvic floor
Understand the development of normal urinary control in pediatrics.
List the 4 phases of defecation and describe the rectal anal inhibitory reflex
Identify common causes of constipation and its’ relationship to bladder dysfunction
Perform visceral and soft tissue techniques for constipation
Describe the pelvic floor relationship to voiding reflexes.
Understand pediatric urology terminology and investigative tools used for testing the pediatric patient.
Discuss education and treatment about diet including bladder health and bladder retraining
Understand pediatric pelvic floor dysfunctions on SEMG as it relates to bowel and bladder function.
Evaluate the effects of posture and positioning on pelvic floor muscle recruitment and relaxation.
Understand the psychological effects of bedwetting, daytime urinary incontinence and fecal incontinence.
Describe behavioral treatments or Urotherapy for pediatric pelvic floor dysfunctions.
Understand the use of surface electromyography (SEMG) in the pediatric patient.
Develop treatment progressions for children with pediatric bowel and bladder dysfunction.
Perform verbal instruction of pelvic floor activation
Perform 3 different diaphragmatic breathing techniques for pediatric patients including diastasis rectus abdominis assessment with examples of core activation.
Discuss the effects of toileting postures on pelvic floor muscle recruitment and relaxation.

Target Audience

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Agenda

Day One:
4:30 Registration 5:00 Anatomy, Normal bowel and bladder function in pediatrics 5:45 Standardization of terminology of bladder function in children and adolescents 6:00 Conditions and diagnoses 6:30 Investigative Tools Part 1- Bladder diaries, uroflow, KUB’s, Ultrasound 8:00 Adjourn

Day Two:
8:00 Investigative tools part 2- urodynamic testing 8:30 Vesicoureteral Reflux- VUR: Definition, medical-surgical management 9:15 Physiology of defecation 9:45 Break 10:00 Lab: Belly breathing with toileting 10:30 Constipation and Encopresis: Definitions, treatment, medications 12:00 Lunch 1:00 ILU and connective tissue massage lab 2:15 Enuresis (Bedwetting): Definition, etiology, medical-behavioral management 3:15 Break 3:30 Dysfunctional voiding 4:15 Psychological considerations 5:00 Medical evaluation 5:30 Adjourn

Day Three:
8:00 Common medications 8:15 Physical therapy evaluation- subjective and objective 9:00 Biofeedback Fundamentals 10:00 Break 10:15 SEMG videos and case studies 11:00 Physical therapy assessment and treatment with video treatment sessions 11:45 Get lunch 12:00 Eat while watching a complete video initial evaluation 1:00 Double Voiding, treatment goals and progressions 1:45 Reimbursement ICD 10 codes & referral sources for marketing 2:00 Start up 2:15 Case Studies 3:00 Break 4:00 Group Case Studies 4:30 Questions and answers 5:00 Adjourn

Description

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), by 5 years of age, over 90% of children have daytime bladder control. What is life like for the other 10% who experience urinary leakage during the day? Bed-wetting is another pediatric issue with significant negative quality of life impact for children and their caregivers, with as much as 30% of 4 year-olds experiencing urinary leakage at night. Children who experience anxiety-causing events may have a higher risk of developing urinary incontinence, and in turn, having incontinence causes significant stress and anxiety for children. (Thibodeau et al., 2013) Having bowel dysfunction such as constipation is also a contributor to urinary leakage or urgency, and with nearly 5% of pediatric office visits occurring for constipation, the need to address these issues is great. (Constipation in Children, 2013) As pediatric bladder and bowel dysfunction can persist into adulthood, pelvic rehabilitation providers must direct attention to the pediatric population to improve the health in our patient populations.
The pediatric population is greatly under-served causing undo stress for the child and family as well as development of internalizing and externalizing psychological behaviors. The two most common pelvic floor dysfunctions in the pediatric population are dysfunctional elimination syndrome and bed-wetting. This specialty continuing education course focuses on the treatment of children with day or nighttime incontinence, fecal incontinence, and/or dysfunctional voiding habits.
This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. The participant will learn terminology from the International Children's Continence Society, medical evaluation concepts for bowel and bladder dysfunction, and common dysfunctions in voiding and defecation. Common causes of incontinence in the pediatric patient will be covered, and a comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor and surface electromyography (or sEMG, a form of biofeedback.)

Date And Locations
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