Why Take Peds Level 1 - Pediatric Bowel and Bladder Disorders?

According to the International Children’s Continence Society (ICCS), typically developing children are expected to achieve both daytime and nighttime bladder control by the age of 6. Failure to achieve this milestone is associated with significant psychosocial consequences for both the child and family, including increased anxiety, frustration, reduced self-esteem, and the development of internalizing and externalizing behaviors.

The most common pelvic floor dysfunctions in the pediatric population include dysfunctional elimination syndrome, urinary withholding, recurrent urinary tract infections, nocturnal enuresis, and fecal incontinence. Constipation is a major contributing factor to urinary urgency, leakage, and bedwetting and accounts for approximately 5% of pediatric primary care visits. Despite the prevalence and long-term implications of pediatric bowel and bladder dysfunction, this population remains significantly underserved.

This course focuses on the evaluation and treatment of pediatric patients with daytime and/or nighttime urinary incontinence, fecal incontinence, and dysfunctional voiding patterns. Children with special needs, sensory processing disorders, and musculoskeletal asymmetries are at increased risk for developing maladaptive bowel and bladder habits, including chronic constipation.

Because pediatric bladder and bowel dysfunction frequently persists into adulthood, early identification and intervention are essential. Pelvic rehabilitation providers play a critical role in improving long-term continence outcomes and quality of life for these patients.

This course begins with a review of pediatric pelvic anatomy and physiology, including the development of normal voiding reflexes and continence. Common medical and behavioral contributors to pediatric incontinence are examined. Participants will learn comprehensive medical and therapy-based evaluation strategies for bowel and bladder dysfunction, nocturnal enuresis, and constipation.

Instruction will include a multimodal approach to assessment and treatment, incorporating video demonstrations of pelvic floor evaluation using surface electromyography (sEMG) biofeedback, rehabilitative ultrasound imaging, and pediatric-specific external pelvic floor manual techniques to facilitate coordinated evacuation. Case studies will be integrated throughout the course to illustrate clinical reasoning, diagnosis-based intervention selection, progression of care, and discharge planning.

References:

1. Nieuwhof-Leppink A, Hussong J, Chase J, Larsson J, Catherine R, Hoebeke P, Yang S, von Gontard A, Definitions, indications and practice of urotherapy in children and adolescents: - a standardization document of the International Children’s Continence Society (ICCS), Journal of Pediatric Urology,https://doi.org/10.1016/j.jpurol.2020.11.006.

2.    Hartless, M., Fraga, M., & Snow, B. (2024). Clinician perspectives on behavioral therapy outcomes for pediatric enuresis. Urology Practice, 11(1), 45–52. https://doi.org/10.1097/UPJ.0000000000000382

3. Ayribas B, Toprak T, Degirmentepe RB, Ozgur MO. Insecure attachment and its relationship with negative self perception in children with nocturnal enuresis. Journal of Pediatric Urology. 2022 Oct:S1477-5131(22)00404-1. DOI: 10.1016/j.jpurol.2022.10.006. PMID: 36307368.

4.   Ata, B., Yılmaz, S., & Şenel, S. (2025). Clinical characteristics of monosymptomatic and non-monosymptomatic nocturnal enuresis in early childhood. Journal of Pediatric Urology, 21(1), 45–52. https://doi.org/10.1016/j.jpurol.2024.09.003

5.    Li, F., Feng, L., Yang, Y., Ma, X., Kang, T., & Huang, W. (2024). The effect of biofeedback on nonneurological dysfunctional voiding in children: A meta-analysis and systematic review. Journal of Pediatric Urology, 20(4), 565–580. https://doi.org/10.1016/j.jpurol.2024.06.042

Evidence-Informed Statement: “Content is based on current literature, clinical practice guidelines, and professional consensus.”