Potty Training: Pelvic Floor Education

When I began this business, of Sleep Consulting, I quickly knew that this platform could be a space where mom’s could hear from, not only me in regards to sleep, but also, many other professionals who can help educate them on the unknowns and unexpected, of the health and well-being of their children.

Not once, during my pregnancy.. even first few months/years of life did I think, “constipation, incontinent and bowel movements are the next topics I need to read about.” But, unfortunately… this is a topic that needs to be discussed more.

I “interviewed,” Dr. Kiley Gibbs, a Pediatric Physical Therapist who specializes in pediatric pelvic floor, contispation and incontinence. Dr. Gibbs was more than willing to work with me, as I wanted to ask a few questions that would help educate mom’s on what exactly to expect when it comes to potty training, and when to seek further support.

Question 1: Tell me about you. What your title is... what lead you down this path to pediatric pelvic floor, constipation and incontinence? 

 I completed my Doctorate in physical therapy and did most of my clinical affiliations in pediatric settings. This solidified my interest in pediatrics and I began working at Mott Children’s Hospital in Ann Arbor, MI after graduating. 

Knowing that I could provide better care with advanced training, I continued on to complete a Pediatric Physical Therapy Residency program through the University of Michigan. This is where I was introduced to treatment of the pediatric pelvic floor and incontinence. It was a new program for us and it made such an incredible impact in the lives of the children and their families. I was immediately drawn to it for that reason, and the fact that so many children are in need of treatment but are often too embarrassed to discuss what is happening.

We had great team collaboration between the psychologists, dietitians, surgeons, gastroenterologists, urologists, and therapy staff to treat these children from all angles of care. I received wonderful mentorship during that time, and was able to continue advancing those skills throughout my time at UofM. I eventually opened up my own private practice in 2018 after moving to Maryland. 

Second: During potty training what is considered normal for daytime and nighttime accidents?

If a child is potty training and will occasionally have accidents because they didn’t know where the bathroom was, this is normal.  Once a child has potty trained, meaning they can identify when they need to pee and poop, and can tell a caregiver or take themselves to the bathroom, other than the scenario mentioned previously, there shouldn’t be any accidents. 

Children needing to urinate frequently, even every 15-45 minutes, may have underlying constipation resulting in increased frequency or accidents between bathroom breaks because the backup of poop is putting pressure on the bladder.  After the age of 5, most nighttime bedwetting is due to a back up of poop putting pressure on the bladder.  Constipation is especially evident when children are having seemingly random dry nights or inconsistent progress with being dry during the day.   

Third: what are signs people should look out for, in terms of seeking further help/guidance?

 Any sort of accidents, big or small after potty training can be a reason to seek further guidance by a pediatric pelvic health expert.  Many times parents are told their child will outgrow it, which is not likely.  There are many simple ways to improve the frequency or quantity expelled in bowel movements in order to decrease pressure on the bladder. 

Fourth: Three basic tips to help with constipation/incontinence?

Making sure that their child is drinking enough water is essential.  Water helps to keep the bladder healthy and flushed out and helps to keep poop moving through the system and soft.  If a child isn’t drinking enough water each day, the bowel movements can become difficult to get out, infrequent, or incomplete, which can result in putting pressure on the bladder.  We need to be drinking half of our body weight in ounces per day (Example: a 50lb child should be drinking 25 ounces of water each day).  

After that, setting up the toilet to have ideal potty posture will allow for more success.  Whether you are using a toddler potty or the regular toilet, the child’s body position should be the same to make sure the pelvic floor muscles able to relax.  The optimal potty posture positions our knees above the level of our hips, around belly button level.  To do this we may need a supportive footstool.

Third, getting enough fiber is essential.  Aim for 4-5 servings of fruits/veggies each day to keep the poop moving through their system. 

Thank you Dr. Gibbs for educating parents on pelvic floor and doing the work that you do. I was so happy to find your page, for my own children and a resource for the families I work with.

If you would like to reach out to Dr. Gibbs her email is kiley@kcgpediatricpt.com and her Instagram account can be found at https://www.instagram.com/theincontinentchild/?utm_source=ig_web_button_share_sheet&igshid=OGQ5ZDc2ODk2ZA==