Two children smiling

Is your child struggling with pee or poop accidents, constipation

or potty training?

PEDIATRIC PELVIC FLOOR OCCUPATIONAL THERAPY CAN HELP

WHEN ACCIDENTS HAPPEN

 Toileting issues are incredibly frustrating for both children and their parents.  

 

"He just won't poop!  I know he has to go but he just holds it for days and days. He's so stubborn!"

"She doesn't seem to notice or even care if she has an accident"

"We have done multiple clean-outs for his constipation and he's still having accidents.  We are at our wits end!"

Toileting issues affect not only the child but also impact the whole family. And unfortunately, the root cause of toileting issues is frequently missed or not adequately treated, resulting in months or even years of continued accidents and frustration. 

 THE ROOT CAUSES OF ACCIDENTS

The most common cause of both pee and poop accidents is CONSTIPATION. Because the bowel and bladder lie so close to each other in the pelvis, pressure from a poop filled rectum can push against and irritate the bladder causing it to empty at unintended times.  

CONSTIPATION is also the cause of encopresis, or fecal soiling/accidents.  When a child intentionally withholds their poop, it becomes hard and impacted in the rectum.  Frequently, smaller bits of stool then "bypass" the impacted stool and the child may not even be aware of the accident.  

PELVIC FLOOR DYSFUNCTION commonly co-occurs with constipation.  When a child intentionally withholds their poop, the pelvic floor muscles grip and tighten and can even move into a "shortened" position.  This makes pooping all the more difficult, as these muscles need to relax and "lengthen" to allow for elimination.  

BEHAVIORAL FACTORS such as those associated with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder (ASD), Sensory Processing Disorder (SPD) anxiety, depression and others impact toileting and accidents. 

HOW WE TREAT THE ROOT CAUSES

As a pelvic floor Occupational Therapy clinic, we at Core Functional Wellness are uniquely equipped to holistically  treat your child's toileting issues.  We work with your child and your family to develop a plan for treatment that may include:

  • Family support and education

  • Education in bowel, bladder and pelvic floor anatomy and function appropriate to child's level

  • Muscle strengthening, relaxation and/or coordination training for core and postural systems

  • Sensory Integration treatment

  • Surface EMG biofeedback 

  • Behavioral and dietary modifications

  • Bladder retraining

  • Autonomic quieting techniques

  • Individualized Home Program with incentive chart

We coordinate with your pediatrician to medically resolve any issues of constipation and we continue to follow up with you for one year to assure the constipation remains resolved, as relapse is unfortunately very common and is the usual reason accidents persist despite treatment. 


We also encourage your child to communicate directly with her therapist via phone or text in between treatment sessions to empower your child throughout their treatment.
   

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WHAT DOES A TREATMENT SESSION LOOK LIKE?

You can expect your child's initial evaluation to last about 90 minutes.  Prior to the initial evaluation you will be asked to complete a thorough medical history and history of the current issue for which you are seeking treatment. We meet with each child and their parent/s or guardian to review this information and get a thorough understanding of your child.  We then do a physical examination looking at the muscles of the abdomen, legs, back and any others we feel may be relevant to your child's issue.  The exam is with an adult present and over clothing.  Based on the initial findings of the physical exam, your therapist may conduct further assessments including large motor, coordination, reflex and/or sensory processing assessments.  Part of the initial evaluation is conducted in the sensory gym so we can assess large motor patterns and so your child can have FUN! Finally, we consult with your child's pediatrician to develop an individualized treatment plan.

Treatment is one-on-one with a licensed and registered Occupational Therapist who has advanced training in pediatric pelvic floor dysfunction.  Treatment directly addressing pelvic floor muscle strength and coordination (with or without the use of biofeedback) is performed in a private treatment room, over clothing and a parent is required to be present.  Treatment addressing sensory integration, core muscle strengthening and/or gross motor coordination is performed in our sensory gym and parental presence is not required. Treatment sessions are usually 60 minutes. Some sessions may be conducted via Telehealth if parents prefer and your therapist agrees Telehealth will work well for your child.  

CONDITIONS TREATED

  • Constipation

  • Potty training difficulties

  • Urinary incontinence (enuresis) daytime and nighttime

  • Fecal incontinence (encopresis)

  • Urgency and frequency

  • Recurrent UTIs

  • Core and postural muscle weakness

  • NOTE: co-occurring issues such as ADHD, ASD, SPD,ODD etc., will also be treated as they relate to the primary toileting issue

FAQS

Pediatric Occupational Therapy

DO YOU TAKE MY INSURANCE?

Core Functional Wellness is contracted in network with several medical insurance providers.  The companies we do not contract directly with may have out of network benefits that are similar and sometimes even better than the benefits you would receive in network.  Contact us to receive an estimated cost for services at Core Functional Wellness.  Additionally, some of our clients use their HSA/FSA cards for qualifying therapy services. You will be provided with a Superbill for your occupational therapy which you can then submit to your medical insurance company for reimbursement for out of network benefits. 

HOW DO I USE MY OUT OF NETWORK BENEFITS? AND HOW DO I KNOW HOW MUCH MY INSURANCE COMPANY WILL REIMBURSE?


Recommended Questions to Ask Your Insurance Provider:

  • What is my out-of-network deductible? How much has been met this year?

  • What portion of my child's services will be reimbursed?

  • Does my plan allow reimbursement for each of the following therapy codes?

    • Evaluations: 97165, 97166, 97167

    • Treatment: 97530, 97112, 97110, 97535, 97140

  • Do I need a referral from a physician to obtain reimbursement?

  • Do I need pre-authorization to obtain reimbursement?

Many of our clients are now using an app called Better which takes care of your out-of-network health insurance claims for you for a zero to 10% fee.  You can find out more at getbetter.co

DO YOU DO INTERNAL PELVIC FLOOR MUSCLE ASSESSMENT?

Internal assessment is never performed on children. Depending on your child's age and the preference of both child and parent, an external visual assessment may be performed to assess muscle strength and coordination.  Pelvic floor muscle strength and coordination can also be screened through external SEMG biofeedback at parent request and child consent.  Parents will be required to be present for any biofeedback assessment or treatment. 

Please note that pelvic floor muscle assessment is not required to receive treatment at Core Functional Wellness. We recognize that a child's toileting issues are never caused solely by pelvic floor muscle issues.  We treat your child holistically looking at diet, sleep patterns, sensory issues and any behavioral issues that could be contributing factors.

LOCATION

Core Functional Wellness is located at 543 Encinitas Blvd #114

Encinitas, CA. 

In-home appointments available to Medicare clients in some areas of San Diego.

 

Consultations and appointments are available to out of area clients through our online Telehealth services.

ASK OUR BOARD CERTIFIED SPECIALIST A QUESTION ABOUT YOUR CHILD'S ISSUES:

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