Pediatric Pelvic Health

Published January 1, 2026

What You Need to Know 

Pediatric pelvic health physical therapy supports children from infancy through early adulthood to manage bladder, bowel, and pelvic pain disorders. Treatment is tailored to each child’s developmental stage, integrating play, family routines, and school goals.

• Infants and toddlers benefit from caregiver-led strategies like toileting posture and abdominal massage.

• School-aged children respond well to interventions like play-based pelvic floor training and structured bowel regimens.

• Adolescents may need multimodal care for improved function and self-efficacy. 

• Early referral improves outcomes, but access remains limited in many areas. 

Pediatric pelvic health physical therapy (PHPT) addresses a spectrum of bladder, bowel, and pelvic pain disorders from infancy through late adolescence and emerging adulthood (birth to 18 years old). Developmentally, dysfunction may arise from delayed toilet training, constipation, withholding behaviors, or sensory-motor discoordination, all of which disrupt maturation of the pelvic floor and continence mechanisms (Sinha, 2011; Tabbers et al., 2014; van Engelenburg-van Lonkhuyzen et al., 2017). Physical therapists therefore individualize assessment and education to each child’s cognitive, motor, and emotional stage, integrating play, family routines, and school participation goals (Chase et al., 2010).

Interventions by Age Group

For infants and toddlers, caregiver-centered instruction in optimal toileting posture, abdominal massage, diaphragmatic-breathing games, and early voiding schedules establishes neuromotor foundations for continence (Chase et al., 2010). Preschool and early-school children benefit from play-based pelvic floor muscle training, surface EMG or ultrasound imaging biofeedback, and structured bowel regimens that combine fiber, hydration, and physical activity (Tabbers et al., 2014; van Engelenburg-van Lonkhuyzen et al., 2017). During adolescence, hormonal shifts and evolving body image coincide with higher rates of dysmenorrhea, persistent constipation, urgency, or pelvic pain. Evidence supports multimodal programs that merge neuromuscular re-education, manual therapy, exercise prescription, hormonal management, and body-affirming education to improve function and self-efficacy (American College of Obstetricians and Gynecologists [ACOG], 2021; Fernández-Pérez et al., 2023; Mansfield et al., 2022).

Special Considerations

Across all ages, clinicians must account for pediatric anatomy (smaller pelvic outlet, unfused coccyx), developing neuromuscular control, and psychosocial factors such as autonomy, privacy, trauma history, and gender identity (ACOG, 2021; Oral et al., 2016). Trauma-informed, inclusive communication improves adherence and outcomes and should extend to caregiver coaching to reinforce home strategies (Oral et al., 2016). Early referral to PHPT can shorten symptom duration, lower recurrence, and reduce caregiver burden, yet the specialty remains under-represented in many communities (Chase et al., 2010; Tabbers et al., 2014; van Engelenburg-van Lonkhuyzen et al., 2017). Recent interprofessional publications call for standardized competencies and interprofessional referral pathways to close this gap and promote lifelong pelvic wellness (Gordon et al., 2025; Mansfield et al., 2022).

Additional Resources

• Professional education and PT-focused courses

  • APTA Academy of Pelvic Health – Pediatric Pelvic Health Resources (PEDSIG, webinars, articles, handouts, and PT/clinic finder).

  • APTA Academy of Pelvic Health – Pelvic Health Level 3 Pediatrics Webinar (age-specific eval/tx, communication, and family dynamics).

• Parent- and child-facing resources
  • ICCS “For Parents & Families” educational materials on incontinence, bedwetting, and bowel issues – great to show patients and also for students to see how experts talk to families.

References