Scott Webb (Host): Pelvic health rehabilitation is most commonly associated with older patients, but as I learned in preparing for my conversation today, there are physical therapists who regularly work with pediatric patients on various pelvic issues. And joining me today is Kendall Seiler. She's a Pelvic Health Physical Therapist practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Kendall, it's so nice to have you here today. We're going to talk about physical therapy, right? And pelvic floor health physical therapy. And I was telling you, I didn't even realize that pediatric patients worked with someone like yourself. So this is going to be really educational for me, for listeners.

But before we get to the pediatric population, just briefly explain in general what pelvic health physical therapy is.

Kendall Seiler, PT, DPT, LAT, ATC: I've been with Franciscan for three and a half years, and in my experience, my youngest patient has been five years old, and my oldest was like a 98-year-old guy. And everyone has a pelvic floor, first and foremost.

 So I tell people that physical therapy, our job is to understand how the body moves. So we tell people that we are skilled movement experts and we have lots of education in how to identify how a body moves as far as their range of motion and their flexibility and their strength, but then bigger picture how that plays a role in their ability to do the things that they want to, right?

Like things for work or exercise, or just being able to clean their house or get in and out of a car. And so when we add in pelvic health physical therapy, it's the same idea. It is the same concepts as any other physical therapist. We just tend to specialize in the mid body area. And so basically that's everything from like your ribcage to your hips.

And that will include your abdomen muscles and that will include your back muscles, and your pelvis, and your hip muscles, and your bottom muscles, then, of course, your pelvic floor muscles. And so we, again, kind of understand how to identify and look at how those tissues and muscles feel, how strong they are, and then how that might play a role in someone'sfunction and quality of life. So that's where our focus is. And, you know, with pediatrics, they have pelvic floors, too. And so it's important to not forget about them, especially, you know, if they can't necessarily,advocate for themselves as much, so.

Host: Yeah, let's do that. Let's focus in on the pediatric population. What age ranges are considered pediatric? I know you said you had a five year old all the way up to near 100, but when think about the kiddos, like, what's the general age range you work with?

Kendall Seiler, PT, DPT, LAT, ATC: Yes, so with my training, I have been educated that someone's bowel and bladder is completely developed at five years old, so typically my youngest is gonna be five. You know, I've had a couple experiences where I get some parents who bring their kiddos in at like four years old and they want to start kindergarten that next year, and they're not toilet trained and so that's kind of where I will give them like a lot of education on some things that they can do.

But I really try to emphasize that physiologically and anatomically, our body is not developed for bladder and bowels until five, and then that can go all the way up until like 18 years old. That's kind of the range that I would consider a pediatric population. And in that, you know, there's so much that you can see.

I think a lot of the main complaints that I will see are like bladder leakage, maybe when they get the urge to go to the bathroom, they can't make it on time, they're leaking on the way, or maybe they are leaking while they giggle, you know, or they cough, or they sneeze, or they like play, which for like imagine, right?

For anyone, let alone like elementary, middle schoolers, that's like so embarrassing. And, and it's not something that they should have to live with. And, you know, we'll see like urinary frequency. So maybe because of the leakage, they're like going to the bathroom every second they can, because they are afraid of leaking.

Or, you know, maybe I have some kiddos where they are just so into this game or they are so into playing that they don't want to step aside from that. And so then they're leaking because they're not listening to their body and going when they have the urge. And then, you know, the constipation or the bowel health that is a wholeworld out there

and so we'll see a lot of kiddos that are constipated, which then is resulting in like belly pain or, you know, pain when they finally poop. So then they don't want to poop again. And then now you're in this cycle of they're going to be holding stool because they don't want to go and then they end up having to go and then they're in pain.

So that's a big thing. And then as well as a fancy term called encopresis. So that is just like when kiddos are really backed up and that stool is kind of compacted in their rectum. And so the newer stool has nowhere else to go except to kind of like seep out around the old stool. And then that will result in soiling of their underwear.

Which again, imagine little kids playing outside and they can't control it. And then, you know, their classmate or whatever's like, oh, something kind of stinks. And then you're like down the rabbit hole of that bothering them or them becoming self conscious, which is, again, something they shouldn't have to deal with.

 And then the whole aspect of pain, right? And so I'll see a lot of kiddos that have maybe like tailbone pain. Maybe they are dancers or they had a fall, or something like that is the other big complaint I'll see too.

Host: Yeah, I was just going to ask you, what are some of the common symptoms that you went through a range there of things from pain to embarrassment and my daughter was much like that. She just couldn't pull herself away from whatever she was doing, you know, and then, so it always a mad dash to the bathroom, sometimes she'd make it, sometimes she wouldn't.

So just give us a sense, like the types of signs and symptoms that both kids, if they're old enough to advocate for themselves, but especially parents can be on the lookout for.

Kendall Seiler, PT, DPT, LAT, ATC: Absolutely, yeah. So, kind of then going into that bladder, you know, like you were saying about the experience with your daughter, if they are just like playing constantly, and they just don't want to step away, and then you find them like running to the bathroom, quite frantically, like of course that's not normal or something we want to encourage, so typically, again if we're looking at that fully developed 5 years or older. Normal is considered emptying your bladder anywhere between like 3 and 8 times during the day. So, that comes out to be every 3 hours, give or take, by the time the kiddo wakes up or goes to bed. So, if you find your kids not emptying their bladder in that range of three to eight times, that could be something to keep a lookout for.

 If you notice your kiddo, you know, going to the bathroom, but again, they want to hurry because they want to get back to whatever they're doing, there could be the potential that they're not emptying their bladder as much as they need to be. So maybe that could present as they might notice like what we call post void dribble, so when they get up from the toilet, they might have some little leaks that come out, or while they're pulling up their pants. That's something, or maybe they step away from the toilet, and then they're like, oh, I just went, but I have the urge to go again, that's something to be on the lookout for.

Obviously, leakage is not normal ever. So, no matter how old you are or what your experiences are in life, leakage with coughing or sneezing or laughing or urgency or exercise, like, none of that is normal and, of course, something that we want to identify. And then, of course, if they're having pain while they're going to the bathroom, that's not good either.

 And then for bowel movements, like as kiddos, the normal as a goal is at least having one bowel movement every day. I joke with all my kiddos, I have this chart in my room that like outlines choose your poo. It's called the Bristol stool chart. And so like, it goes anywhere from rabbit pellets to like, does your poo look like a bunch of grapes?

Does your poo look like corn on the cob? Does your poo look like porridge! And then I always like, oh man, you're never going to want to eat corn on the cob again, you know, joking with them. But of course we want to strive for that smooth like a banana, firm but softer stool.

And then, you know, if they are having pain with bowel movements, that's something to be on the lookout for. If they're having that leakage, maybe like skid marks in their underwear, that could be a sign that they're not completely emptying their bowels as well. And then anything that just impacts like their quality of life.

So, you know, if they are on the playground playing and they're having back pain or tailbone pain or something like that, or they are not able to participate in their gymnastics or their dancing, or anything like that. I had one little girl, she had fallen a couple times and she hadn't been able to ride her bike because of the tailbone pain. And so just imagine, like, being a 13 year old, not being able to ride your bike to your friends or something like that. So.

Host: Well, I am going to be laughing and smiling about choose your poo. Uh, it's just not an expression that I'm used to hearing, and I'm going to be smiling about that for quite some time. Just wondering, is a referral needed from a pediatrician to see you?

Kendall Seiler, PT, DPT, LAT, ATC: So it of course, depends on insurance. So just like you know, any other physical therapy for someone, so more of our state provided insurances typically do require a referral from a pediatrician or, you know, I get a lot of referral sources from urology, or from gastroenterology. Or if depending if it's more of like a commercial insurance, it's always good to check with your insurance to make sure that the provider, whoever you're going to see, is of course in your network.

But then, you know, typically with that, we have what's called direct access. So, we can see patients for up to 42 days without a physician referral, again, depending on insurance. But that's a good at least foot in the door so that I can see the person and then, you know, if I need to ask for a referral, it's just a phone call and a fax away from being able to get that.

Host: Yeah, it's always, you know, if you aren't sure, check with your insurance, just to make sure. I just want to give parents and patients too, obviously kids too, but a sense of what's that like first visit like when they come to see you. Generally is there a range of how many sessions are needed or is it really sort of patient and issue specific?

Kendall Seiler, PT, DPT, LAT, ATC: Yeah, that's such a great question, and you know, in my experience of seeing pediatric pelvic health, it can be a little daunting or people can be uncertain about like what we do and, what all that entails, especially as like a young kid who can barely understand their body. And especially such like a private part of your body can also be really hard to talk about.

Like who really actually wants to talk about going pee and going poop? Like I have a running joke in our family that I love talking about that, but I also have to remember not everyone loves talking about poop and stuff like that. So, first, like we just want to make sure that the loved one, that parent, that guardian, and that kiddo of course feel comfortable, so we have a nice little packet that we typically email out to the family to go over with their child prior to coming in, and it just explains what we're going to be doing, and I tell people that my job is to assess the muscles and those muscles are your belly muscles and your pelvic floor muscles. And that is what helps you go to the bathroom. And so, you know these are the different ways we'll do that. Like we will watch you move and watch you skip and watch you jump and watch you like get up off of the ground. And then, you know, I always like to tell kiddos that I'll feel their belly.

I want to, you know, see is there any tenderness or pain that they're having, , and I want to see how strong they are. And, think just educating them that your pelvic muscles are just like any other muscle in your body, like the muscles that help you run and jump and help you skip and help you do push ups and handstands and all of that stuff, these muscles are just as important as those muscles.

 And I think the other big thing too is just making sure that they feel comfortable. I've had a handful of times where the kiddos have come into my office and they think they're going to the doctor's office, they think they're going to get shots, and like, they obviously no one loves shots, and so then that also tends to add to a little bit of fear or they just don't feel as comfortable with me.

So, you know, if we can kind of address that right away as far as what they know to expect, that can be helpful. And that's kind of what that first visit looks like is just kind of getting to know the child, getting to know the family, hearing what's going on, and then just getting some of those baseline measurements with their muscles and their flexibility and how they move.

 And then as far as like follow ups, I will always tell people that my job is to give you guys the best care and of course we can kind of figure out what that looks like together. I would say on average, I will see patients or my kiddos like once a week and that range can really range anywhere from like five to six weeks, you know, up to like a few months and like you said it really just comes down to like what are we doing in PT and what's helping?

But then are we also meeting their goals and their expectations for improving their quality of life? The other really neat thing, I've had a handful of patients who they've driven over like an hour and a half one way just to come see me because this is such a like niche patient population that provides care for these kiddos. And so if coming in once a week is not doable, then we also offer telehealth, which is really great, and so that's just our physical therapy sessions completed over a safe platform so we can do appointments virtually, so that's a really good resource for our people that it's not as easy to come in to.

Host: Yeah. Yeah. We've all learned over the last few years, the value of these virtual sessions. I've done some with my doctor, just sitting at the kitchen table. Hey doc, how's it going? You know, right. So you can actually, you could do physical therapy, you know, over the phone, so to speak. So, good stuff today. Fun, educational, as I anticipated it would be. Just give you a chance here at the end. Final thoughts, takeaways, when we think about this population you work with, you know, peds patients, kiddos, uh, and how you can help them.

Kendall Seiler, PT, DPT, LAT, ATC: Yeah, you know, I think, like we were talking about earlier, these kids, it can be hard for them to understand, like, what's normal and what's not normal, and as a parent and a guardian, you know your child best. So my biggest advice is to just like make sure you're advocating for yourself, for your family, and for your child.

If you feel like something's not right, make sure you bring it up, ask questions and just know that there's help out there. And this is not something that you have to live with. I'm starting to notice that these trends of like I'm getting these older adults that are also coming in and they're like, oh, I've had this going on, you know, as a child, but I didn't even know that there was this help out there.

 So I think being able to have the information and you get to decide what you want to do with it, but at least knowing that there are options out there and it's not something that you have to live with is so crucial to everyone's health.

Host: Yeah, that's perfect. And so right, you know, and we all suffer with things we don't have to suffer from. And I think one of the real values in these Franciscan Health Podcasts is just getting the word out, is just educating folks like, hey, if you're suffering or your kiddo's suffering, there is help available.

You just have to maybe check with your insurance and just reach out and advocate. Good stuff today. Thank you so much.

Kendall Seiler, PT, DPT, LAT, ATC: Yeah, yeah. Thank you so much for having me. I really appreciate it.

Host: And for more information about Pediatric Pelvic Health Physical Therapy Services at Franciscan Health, visit franciscanhealth.org and search Pediatric Pelvic Health.

 And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.