Monthly Archives: May 2015

What’s new in pelvic health? Reading homework included.

I love reading blogs about pelvic health, the human body, chronic pain, movement, neuroscience–and especially get excited if these things get combined together. Periodically, I’d love to simply do a blog on blogs, so that is what you get today. Basically, it is a quick list of blogs, journal articles, random articles, and possibly books that I am reading right now. There are SO many great things out there. I hope you enjoy, and have a great friday! 🙂

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1. The Pudendal Neuralgia Wrecking Ball. Of the different diagnoses in the chronic pelvic pain world, pudendal neuralgia is often a scary one for a patient to hear. Not because it’s untreatable–it IS treatable. But simply, because , and unfortunately, many patients with this type of problem (like SO many other problems related to pelvic pain) are often misdiagnosed many times before receiving help and assurance, and often find scary and less than assuring things when researching online (leading to high levels of worry and fear).  So, this article on US News and Reports came out recently. As pelvic PTs, we always love to have big news websites post information to bring awareness to pelvic pain problems. But we took some issue with exactly how that was done and some of the information which was provided…which lead to this excellent response by Stephanie Prendergast, PT of the Pelvic Health and Rehabilitation Center in California (If you don’t follow their blog, you really should! They consistently put out fantastic, high quality information.) And then, led to this response by Sara Sauder, PT, who writes her own blog, focusing all on pelvic pain (it’s great too!). Read these posts–they have great information in them!

2. Can’t Get Enough of the Diaphragm. March was really the month of the diaphragm. Not only did you get my post on the 6 reasons why the diaphragm is the coolest muscle ever, but Ginger Garner (who also has a great blog with a big emphasis on women’s health) went into great detail on this post, expanding on how important the breath really is. I’ve written a lot recently on the importance of breathing with movement and coordinating the breath with other muscle activation, but is holding the breath ever a good strategy? Julie Wiebe gave great insight into that in this post here. (And you know Julie posts awesome stuff!).

3. Movement Variability. As humans, we are designed for movement. Typically when people have pain, their movement patterns become more rigid, and they can often develop alterations where their bodies are guarding movements by pain. Retraining slow, controlled motions with a lot of variations is an important component of treatment! For those without pain, movement variety is key to keeping healthy bodies! That’s why I loved this post by Katy Bowman (my favorite biomechanist) on sitting variations while playing with her child.

4. Share MayFlowers: Women’s Health Awareness. My list would not be complete without a shout-out to Jessica McKinney’s excellent work with Share MayFlowers. SMF is a public health initiative aimed at improving awareness in Women’s Health, and Jessica has been posting excellent information all month long! She highlights women who are doing fantastic things to support WH initiatives, and links to great blogs, articles, etc. out there! A few of my faves from this month are this New York Times article which discussed an innovative form of sex education for adolescents, and this post, bringing awareness of obstetric fisulas.

Hope you enjoy! Now it’s your turn– what are you reading? I’d love to hear in the comments below!

Bedwetting- what’s a parent to do?

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Bedwetting is fairly common in children. In fact, close to 1 in 10 children over 5 years of age experience frequent bedwetting, or enuresis, meaning having accidents more than 3 nights per week. Bedwetting has many causes, but the most common (according to the International Children’s Continence Society) are:

  • Most bedwetting children are very difficult to arouse at night
  • Many children have kidneys that produce too much urine at night
  • The bladder may be smaller or contract too frequently in children who experience bedwetting

If your child is experiencing bedwetting frequently, and is over 5 years of age, there is help available! The first step is to talk with your pediatrician. Your doctor may refer your child to a specialist, or may treat the child herself.  The doctor will evaluate your child for other medical problems which can be related to bedwetting, and may recommend using a common medication called Desmopressin which helps for children who are producing too much urine at night. If your child is having daytime accidents or constipation, it is important that these problems are addressed before the bedwetting. This is crucial as we find that often times, nighttime problems resolve once the daytime problems are addressed.

Many parents are shocked to learn that physical therapists like myself often help children with bedwetting problems—we do! Typically, we help with the following:

  • Supporting you and your child build stellar bladder habits. Typically, parents and children are given diaries to fill out at the first visit so we can look at everything from fluid intake to volume of urination, frequency of urination, regularity of bowel movements, and other factors. This helps us make very specific recommendations for your child to improve habits which may be contributing to problems. Remember, if your child is having daytime accidents along with nighttime problems, we will always address the daytime problems first!
  • Managing constipation or other bowel problems. Constipation is the worst—and often plays a huge role in bladder problems! We work with children to make sure they are “happy poopers”—teaching children how to sit properly on the toilet, improve dietary habits, and build a strong bowel routine.
  • Making sure the pelvic floor muscles are working properly. Some children will have “dysfunctional voiding” or “paradoxical contractions” basically meaning their pelvic floor muscles are not relaxing when they should to help the child empty the bladder or bowels. We use external surface electrodes and animated biofeedback to help parents and children see a visual of the muscles and retrain the needed coordination for proper functioning. This is important to make sure the bladder is emptying the way it needs to during the day.
  • Managing an alarm training program. After medication, alarms are actually one of the most recommended first-line treatments to improve bedwetting. There are some alarms that go on the bed itself, and others than clip inside the child’s pull-up or underwear. Typically, kids who regularly experience bedwetting are heavy sleepers, so the alarm helps to wake the child up to use the bathroom. Your physical therapist will help train your family how to use the alarm, and checks in with you regularly to make sure everything is going as it should.
  • Daytime or nighttime bladder training. If the alarm doesn’t work, dry bed training can be used to help identify the time the accident is occurring and slowly train the bladder. This technique is designed specifically for the individual child based on diary information. For both this and alarm training, Moms and Dads play a big role in making this successful!

Do you have any questions about physical therapy for bedwetting? Colleagues, is there anything you would like to add about physical therapy for enuresis? Please let me know in the comments below!! If you live in the Atlanta area and your child is experiencing bedwetting, call my office today to set-up an appointment!

Here are a few great resources on bedwetting:

Educational Booklets from the International Children’s Continence Society (ICCS): There are so many great ones here on everything from constipation to bedwetting!

Practical consensus guidelines for the management of enuresis: A journal article published by the European Journal of Pediatrics in 2013, open access.

PottyMD.com: A great website that sells books, alarms, watches, etc. to help children with potty problems.

“Do you need to go potty?” 5 Tips to Improve your Kiddo’s Bathroom Health: Written by me J

4 Children’s Books to Improve your Child’s Bathroom Health: Written by me—a great one on bedwetting in there J

Have a great week!

Jessica