Is This Just a Phase? When to Consider Pediatric Pelvic Floor Therapy for Your Child

Dr. Lauren Galipp, OTD, OTR/L

As a parent, it's natural to wonder if the challenges your child is facing are just part of growing up. From potty training struggles to accidents and constipation, many children experience issues with bowel and bladder control. But how do you know when it's more than "just a phase"? As a pediatric pelvic floor therapist, I want to share the signs that it might be time to seek help and how pelvic floor therapy can make a difference.

Potty Training: When ‘Hard’ Becomes ‘Help!’

Potty training can be a stressful milestone for both parents and kids. While it's normal for your child to occasionally resist stopping to potty, or have sporadic accidents when it is all still new, consistent struggles might indicate a deeper issue. If your child:

Resists sitting on the toilet
Cries or becomes anxious at potty time
Has frequent accidents well past potty training age (age 4 or older)
Holds stool or urine for long periods
Voiding stool only in diapers/pull ups or underwear when urinating on the toilet

...then it may be time to consider pelvic floor therapy. These behaviors can sometimes reflect pelvic floor muscle dysfunction, constipation, developmental delay, sensory or inattention challenges, or even past negative experiences with toileting.

Daytime Incontinence: Urine or Fecal Leakage

Daytime urinary incontinence or nighttime bedwetting beyond the age of 5 is common but shouldn't be ignored. If your child:

Has sudden, frequent urges to urinate
Leaks urine before reaching the bathroom
Complains of pelvic or lower belly pressure
Leaks when jumping, laughing, or playing
Is embarrassed or withdrawing socially because of accidents
Doesn’t seem aware of, or timely respond to, bladder or bowel cues

...they may benefit from pelvic floor therapy. We work to retrain the bladder-brain connection, promote healthy voiding habits, and improve pelvic muscle coordination through child-friendly techniques.

Nighttime Wetting: So.Much.Laundry. (& Stress!)

Nighttime wetting (also called nocturnal enuresis) that persists beyond age 5 can be frustrating for families—and confusing for children who truly don't feel the urge to wake up and go. Some signs that this issue should be explored further include:

Urine or stool accidents at night with or without waking
Sleep difficulties including restlessness, difficulty falling or staying asleep, insomnia, mouth breathing/snoring, deep sleep/difficulty waking, or child not waking rested
Infrequent bowel movements (less than 3x/week) with hard to pass stool which can cause an overstretched bladder or rectum and excess pressure on bladder
Sensory processing challenges/not waking as easily to bladder/bowel sensations

Pediatric pelvic floor therapy helps rule out physical causes, screen for sleep difficulties for proper referral, improve constipation, and rebuild that sensory awareness through targeted exercises, behavioral strategies, and adjustments to bedtime and sleep routine.

Constipation: The Hidden Culprit

Constipation is one of the most under-recognized causes of bladder and bowel problems in children. Signs that constipation might be contributing include:

Fewer than 3 bowel movements per week
Large, painful stools
Bleeding with bowel movements
Stool accidents or skid marks in underwear (encopresis)
A feeling of incomplete emptying or no urge to poop

Chronic constipation can stretch the rectum, dulling the natural urge to go and leading to overflow accidents. Pediatric pelvic floor therapy can help by teaching your child how to fully empty their bowels, relax overactive pelvic muscles, and develop a regular routine.

When to Reach Out

If you've tried standard approaches—timed voiding, dietary changes, reassurance—and your child is still struggling, it's worth talking to your pediatrician about a referral to a pelvic floor therapist. Earlier intervention can:

Prevent chronic problems and emotional distress
Support independence and confidence in toileting
Improve quality of life for the whole family

What Therapy Looks Like

Pediatric pelvic floor therapy is gentle, play-based, and tailored to your child. It does not include internal exams. It often includes:

Education about bladder and bowel health and good habits
Exercises to improve muscle awareness and strengthen necessary muscles
Sensory processing exploration and tools for improved regulation
Behavioral strategies to improve focus/attention and interoception (awareness of body sensations).
Breathing and relaxation techniques
Toilet posture training
Nutritional guidance to promote optimal bladder and bowel function
Home routines and rewards to encourage success

No parent wants to see their child struggle with something as fundamental as using the bathroom. If you're wondering whether this is just a phase, trust your instincts. Pediatric pelvic floor therapy might be the supportive step your child needs to move forward with confidence and comfort.

You're not alone—and it’s not too early to ask for help.

Schedule a free 15-minute consult or initial evaluation with one of our pediatric pelvic floor therapists HERE. We can help virtually all over the world and in-person in the Dallas-Fort Worth, TX area.