Rethinking Pediatric Incontinence

Blog PEDS1. 1.9.24

Dawn Sandalcidi PT, RCMT, BCB-PMD is a trailblazer and leading expert in the field of pediatric pelvic floor disorders. Dawn is a national and international speaker in the field. In addition to lecturing internationally on pediatric bowel and bladder disorders, You can join Dawn Sandalcidi with HW in her courses, Pediatrics Level 1 - Treatment of Bowel and Bladder and Pediatrics Level 2 - Advanced Pediatric Bowel and Bladder Disorders. Her next HW course, Pediatrics Level 1, is scheduled for February 3-4 and still has seats available for registration.

In the realm of pediatric pelvic health, the issue of urinary and fecal leakage is a subject that demands a nuanced understanding. Too often, these incidents are dismissed as mere "accidents," inadvertently subjecting children to shame and stigma. It's crucial to recognize that in many cases, children are grappling with conditions such as enuresis and encopresis, which are not behavioral issues or mistakes but rather manifestations of underlying health issues. In this blog, we'll explore the issue of the most common pediatric bowel and bladder disorders, the challenges faced by both parents and healthcare professionals and the need for a holistic approach to treatment.

Understanding the Scope of Pediatric Incontinence

Enuresis and encopresis are clinical terms used to describe involuntary urine and fecal leakage, respectively, in children beyond the age when such control is typically expected. Contrary to common misconceptions, these occurrences are not the result of a child's intentional mistake. Instead, they often signal underlying physiologic disturbances as well as pelvic floor and core dysfunction, which can have wide-ranging effects on a child's physical and psychological well-being.

Causes of enuresis and encopresis can vary, encompassing a range of physical and psychological factors. In many cases, these conditions are linked to pelvic floor dysfunction and bowel issues such as constipation. However, other contributing factors may include genetic predispositions, neurological issues, hormonal imbalances, and emotional stressors. Traditional approaches, such as the outdated notion of letting a child "grow out of it," fail to recognize the multifaceted nature of these conditions. Such passive strategies not only prolong the child's suffering but also perpetuate societal misconceptions around pediatric incontinence — ” What’s ‘wrong’ with these kids?”. Truly, nothing is “wrong”, except that children aren’t granted the access they need to professionals equipped to help. It is imperative to replace such antiquated views with informed, proactive approaches that address the root causes of enuresis and encopresis, providing children with the support and interventions they need to thrive.

Enuresis and Encopresis: Current Challenges

Only about 15% of children per year will organically “outgrow” bedwetting. This statistic underscores the prevalence of the issue and highlights the need for a compassionate and informed approach. Many children experiencing urinary and fecal leakage endure shame, embarrassment, and self-esteem issues, leading to internalizing and sometimes externalizing psychological behaviors.

Parents and healthcare workers encounter formidable challenges when confronted with pediatric incontinence. Beyond the inherent complexities of addressing the physical and emotional well-being of affected children, navigating the healthcare landscape presents additional hurdles. The prevailing societal perception that dismisses these incidents as mere "accidents" contributes to the challenges parents and healthcare professionals face. One of the primary obstacles is the scarcity of trained healthcare providers specializing in pediatric pelvic health. Locating professionals with the expertise to address the nuanced complexities of enuresis and encopresis can be a daunting task, often resulting in delayed or inadequate care.

Moreover, time constraints faced by healthcare providers pose another significant challenge. Parents seeking assistance often find themselves struggling to locate professionals who not only possess the necessary expertise but also have the time to listen attentively to their concerns. In a system where healthcare practitioners are stretched thin, the need for personalized attention and understanding of the intricate nature of pediatric incontinence can be overlooked.

Navigating the intricate web of insurance and referral systems exacerbates the situation. Healthcare workers often grapple with bureaucratic hurdles that can impede the timely access of patients to necessary interventions. Delays in appointments due to administrative complexities not only prolong the child's suffering but also add to the stress experienced by both parents and healthcare providers.

Furthermore, the societal misconception surrounding pediatric incontinence compounds the emotional burden on families. The prevailing notion that these incidents are either behavioral or somehow otherwise the fault of the child contributes to a culture of silence, making it challenging for parents to seek support and understanding from their social circles. The stigma associated with pediatric incontinence can lead to feelings of isolation and shame, inhibiting open discussions about the challenges faced by affected children and their families.

In light of these challenges, it becomes evident that addressing pediatric incontinence requires a multi-faceted approach. Dawn Sandalcidi, a trailblazer and seasoned practitioner in pediatric pelvic health, emphasizes that these issues go beyond the pelvic floor. Children with pelvic floor dysfunction often present with ribcage and core dysfunction, necessitating a broader perspective in treatment. Without a “how-to” manual, Dawn tackled these issues head-on. She incorporated her decades of clinical experience and developed coursework such that other practitioners in the United States (and around the world!) can more easily access effective training on how to treat the pediatric pelvic floor. 

Efforts should be directed not only toward enhancing the availability of trained healthcare professionals but also toward dismantling societal misconceptions and streamlining administrative processes. By fostering a more supportive and informed environment, we can empower parents, healthcare workers, and, most importantly, the children affected by enuresis and encopresis to navigate the intricate landscape of pediatric pelvic health with resilience and understanding.

A Holistic Approach to Pediatric Pelvic Health

Dawn Sandalcidi's courses offer a comprehensive understanding of pediatric pelvic health. Pediatrics Level 1 - Treatment of Bowel and Bladder Disorders covers the basics of pediatric pelvic floor anatomy, physiology, and voiding reflexes. Biofeedback and ultrasound techniques provide less invasive alternatives for children. Pediatrics Level 2 - Advanced Pediatric Bowel and Bladder Disorders expands the focus beyond the pelvic floor, examining the entire musculoskeletal system in more complex cases, offering evaluation and treatment techniques that “zoom out” to look at the whole child. 

Acknowledging that children don't comprehend pain in the same way as adults, a biopsychosocial approach is essential. The incorporation of enjoyable elements makes the treatment process more accessible for young patients.

It's time to shift the narrative around pediatric incontinence. Labeling these incidents as accidents not only oversimplifies the complex challenges children face, but lends to an environment where children aren’t able to truly heal - not just physically, but mentally and emotionally as well. Dawn Sandalcidi's expertise underscores the need for practitioners to view pediatric pelvic health holistically, and to move toward a trauma-informed approach. By understanding the interconnectedness of pelvic and full-body musculoskeletal health and adopting innovative treatment approaches, we can empower both children and their families to navigate the complexities of pediatric incontinence with compassion and understanding. Let's move beyond the 'accident' label and foster an environment where children feel supported, not ashamed, in their journey to health and well-being.

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