Hello! Happy new year!
I have had an exciting couple of weeks here in Constipation Coach land. I made my podcast debut last week, and on a pretty prestigious platform, no less. The American Physical Therapy Association Academy on Pediatric PT featured me and my friend and colleague, Dr. Patti Berg-Poppe, on its most recent podcast episode. You can watch the interview here, or access the audio podcast on your favorite podcast app.
One thing you’ll learn when you read my book (coming soon!) is that kids with bowel and bladder issues often have a hard time relaxing their pelvic floor muscles (these are the muscles that contract to keep you from peeing your pants when you have a strong urge). They have trained their pelvic floor muscles to contract all the time, and can’t fully let go to get all their pee and poop out when they’re on the toilet.
How do you know if a child has difficulty relaxing the pelvic floor muscles? You can look for these signs:
- They report a strong urge to pee, but when they finally get to the toilet it takes a minute for the pee to come out, and then it only comes as a trickle; or,
- They have to strain to pee, so it sounds strong like a firehose while coming out; or,
- They go to the bathroom frequently, like 30 minutes after they just went; or,
- They have frequent UTIs; or,
- They have frequent episodes of urinary incontinence.
In the clinic, we use biofeedback to train kids how to properly use these muscles. Biofeedback involves putting surface electrodes (we call them “stickers”) on a child’s bottom and using a computer to teach the child when they are contracting and relaxing their pelvic floor.
One thing I noticed in my practice was that if a child had a high resting tone (meaning, they weren’t relaxing their muscles), we could lower that tone by having the child do a bunch of wide-legged frog squats followed by a minute or two in child’s pose. I wondered if was just my experience, or if it could be replicated in a more controlled situation. So, I contacted Dr. Berg-Poppe.
Dr. Berg-Poppe is the chair of the University of South Dakota’s physical therapy program. She’s a busy person, but she was game to design a research study to validate what my colleagues and I were seeing in the clinic. Patti did all the hard work: she wrote up the study, got it approved, and sent letters to physicians to recruit patients. She also bought little rewards for us to give the recruits to thank them.
Once we had our subjects, several therapists at LifeScape (where I work) collected the data. The child came in twice: once to have their resting tone measured before and after belly breathing (which is known to lower pelvic floor muscle tone), and once a couple of weeks later to measure their resting tone before and after doing frog squats and child’s pose.
A couple of months later, Dr. Berg-Poppe got to work again, this time analyzing the data. The results? We found that the frog squats followed by child’s pose were just as effective as belly breathing at lowering pelvic floor muscle tone!
Why does this matter? Well, it matters because not every child has access to a therapist who is trained to use biofeedback on the pelvic floor muscles. There aren’t many of us, especially in my part of the country. If I want to help as many kids as possible avoid constipation and incontinence, I need to have some interventions that aren’t limited to a very specialized group of therapists in the clinic. Belly breathing is also effective at lowering pelvic floor tone, but it is hard for some kids to do this effectively and without supervision in the home setting. Squats and child's pose are easy!
How can you put this to use? Piece of cake. If you know a child who has any of the symptoms of pelvic floor dysfunction (listed above), have them do as many frog squats as they can, followed by two minutes in child’s pose. Then have them go sit on the toilet. See if they pee and poop quicker and with less straining. If they do, then they’re on the right track and they should repeat this practice this every day, or a couple of times a day.
You’ll learn more strategies for relaxing the pelvic floor muscles in my book, which will be out in a few short weeks. I hope you’ll read it and share it with all of your friends.
I’ll be in touch when I know the release date for the book. In the mean time, add my email addressed to your contacts: firstname.lastname@example.org, and reach out to me if you have any questions.
Best wishes in 2022!
Christine Stephenson, AKA The Constipation Coach