This past Wednesday, August 26, I had the opportunity to speak at New York Presbyterian Hospital/Weill Cornell about pediatric bowel dysfunction, the benefits of pelvic floor physical therapy, and biofeedback. The lecture was attended by approximately fifteen physicians and clinical fellows, and they were a wonderful and captive audience. Not only did they listen attentively and ask excellent questions, but they even managed to enjoy their breakfast despite the topic. Mad props to the Pediatric GI department!
The first segment of the lecture was a review of pelvic floor anatomy and function, as well as normal bowel function and physiology. I then addressed several frequently diagnosed bowel dysfunctions, including pelvic floor muscle dyssynergia, constipation, encopresis, and toilet refusal syndrome (i.e. when a child refuses to defecate in the toilet despite demonstrating the ability to use the toilet for voiding. This is not to be confused with toilet phobia, which is when a child refuses to use the toilet for both voiding and defecating). I also discussed how stool retention is connected to constipation and various factors that may cause stool retention.
The lecture then shifted gears and moved in the direction of how physical therapy can help children who experience bowel dysfunction. Those in attendance learned what pelvic floor physical therapists assess in a pediatric evaluation, including lumbar and hip musculoskeletal screening, scar tissue or diastasis recti assessment, and the components of an external pelvic floor evaluation. They also learned how the pediatric evaluation differs from the adult evaluation, most noteworthy that the pediatric evaluation is entirely external. No internal techniques are utilized in either evaluation or treatment of the pediatric patient. Instead, physical therapists rely on external testing, including surface electromyography (EMG) and biofeedback. Biofeedback is used to help the child learn how to use their pelvic floor muscles properly, and it facilitates neuromuscular re-education (i.e. creating a stronger mind-body awareness for improved motor control). Other components of treatment addressed in the presentation included appropriate hip exercises, ILU colon massage, toileting posture education, breathing exercises, and proper diet (both fiber and fluid recommendations).
This speaking engagement inspired me to further research and review my knowledge of pediatric bowel dysfunction. I am truly grateful for the opportunity and ability to share knowledge with others, especially information about my beloved profession. On that note, I am happy to discuss bowel, bladder, or sexual dysfunction with any individual or audience that would like to learn more. If you are aware of a group that would benefit from a similar lecture, please inform me! It would be my pleasure to share knowledge with you.