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Pelvic Floor Physical Therapy for Poop Withholding and Constipation in Kids

Updated: Feb 4, 2022

Did you know that constipation occurs in at least 12% of children?

Childhood constipation accounts for as many as 30% of visits to pediatric gastroenterologists as well as 3% of visits to general pediatric clinics.

Withholding poop and childhood constipation is common occurrence and can be successfully treated and prevented using a multidisciplinary approach that includes specialized Pelvic Physical Therapy.

Let’s start by discussing signs/symptoms of constipation in children. These can include any or all of the following:

  • Abdominal pain

  • Bleeding or pain with poops

  • Changes in peeing frequency

  • Poo leakage (liquid stool moves around the impacted stool)

  • Lack of appetite

  • Less than 3 poop's per week

  • Lumpy or hard stools

  • Reflux

  • Stools that plug the toilet (can be large and hard)

  • Straining

  • Urinary incontinence (pee leakage)

  • Increased frequency of urination

Active or "unknowingly" withholding poop can lead to constipation and many of the symptoms listed above. Here are some signs/symptoms of withholding in children:

  • Sitting on your heels

  • Crossing legs or sitting with legs "held tight"

  • Sitting on a chair or surface "differently" than normal

  • Hands on lower abdomen or pelvic region

Now that you are aware of some signs/symptoms of constipation and withholding, let’s talk about the next steps. It is important to make your pediatrician aware or to seek further recommendations from a pediatric gastroenterologist. Doctors such as these may make recommendations regarding bowel medications to assist in “cleaning out” your child, often recommend keeping your child’s stool soft to prevent further problems, as well as rule out other more serious causes of constipation that need immediate medical attention. However, medications alone will not always break the habits contributing to your child’s constipation. This is where pediatric pelvic floor physical therapy comes into play.

Pediatric Pelvic Floor Physical Therapy

Pediatric Pelvic Physical Therapy is a highly specialized area of rehabilitation that can address chronic constipation, withholding, and pee or poo accidents among other dysfunctions of the pelvic girdle. This type of physical therapy utilizes unique intervention techniques to address any tightness, weakness, or coordination issues present in the pelvic floor and pelvic girdle muscles that are typically impaired and contribute to constipation. The Pediatric Pelvic Physical Therapist works closely with your pediatrician, gastroenterologist, pediatric urologist, or referring physician to increase the regularity of BM’s, improve stool consistency, reduce withholding, reduce poo accidents, and reduce medications utilized to facilitate BM’s.

Let’s look at typical interventions utilized at pediatric pelvic physical therapy to treat constipation:

Abdominal massage

  • Taught to parents or child, this specific colonic massage technique helps facilitate a bowel movement.

Breath Work

  • The diaphragm (muscle that assist with controlling breathing) and pelvic floor muscles (at the base of the pelvis that surround the pee/poo holes) work together to generate pressure, relax anal sphincters, and lengthen the pelvic floor muscles when having a bowel movement.

    • These are often uncoordinated in children with constipation.

Coordination Exercises

  • The pelvic floor muscles surround the anal openings and play and important role in having a bowel movement. In children that have constipation, they are often uncoordinated—i.e. the child is squeezing these muscles instead of relaxing them when attempting to pass a bowel movement.

    • Coordination exercises can re-train these muscles to function as they should and thus improve constipation.

Myofascial Release

  • Manual therapy techniques to abdominal and pelvic girdle muscles that can tighten up or spasm and contribute to chronic constipation.

Visceral Mobilization

  • A manual therapy technique that can be directed at many of the organs in the abdomen or pelvis to stimulate improved bowel mobility and motility


  • A modality often used in pelvic rehabilitation that aids in re-training the coordination of your pelvic floor muscles, reducing chronic tension, and improving pelvic floor strength.

  • We are fortunate to have several different types of biofeedback machines in our clinic including the EMYO (which has kid-friendly animations/games to aid in retraining) as well as Rehabilitative Ultrasound Biofeedback which can measure rectal diameter, retrain pelvic floor muscle functioning, and give an objective measure of constipation without the harmful radiation that accompanies X-Rays or KUBs.

Postural Education

  • Teaching patient’s “Proper Pooping Posture” is imperative to ease and complete evacuation when having a bowel movement.

    • Habitual postures that family members are unaware of as well as withholding maneuvers are not always ideal may also contribute to constipation.

Therapeutic Exercises

  • This is a large category of interventions that are utilized in treating children with constipation. This includes strengthening the pelvic floor muscles (surround the anal opening) as well as other muscles of the pelvic girdle that support the abdominal and pelvic region.

    • Exercises can include deep/frog squatting (to promote squatting posture that assist in having bowel movement), over ball stretch (stretching abdominal region), and “superman on hands-knees” (assists in strengthening the core) to name a few.

Not all Pelvic Floor Physical Therapy is created equally---especially when it comes to treating children! Do your research and find a qualified Pelvic Physical Therapist who has extensive training in Pediatric Pelvic PT! Check out our About Us page for my experience in treating children with constipation or who withhold poo. Also refer to our Pediatric Pelvic Physical Therapy Page for more information on conditions we have experience treating. Not local to Midland, Texas? Check out a previous blog post that will guide you in finding a local Pelvic Physical Therapists who can help treat your child's constipation or withholding!


© Amanda Moe 2022. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Amanda Moe and/or COM-Physical Therapy 2022 with appropriate and specific direction to the original content.

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