What age group does EMpower PT cater to?

EMpower PT caters specifically to children ages 0–5 years. We also offer specialized programs such as school readiness and scoliosis treatment for older children who may benefit from continued support.

What are early intervention services in pediatric physical therapy?

Early intervention services support infants and toddlers ages 0–3 with developmental delays or disabilities. These sessions target movement, strength, and coordination to promote healthy development. EMpower PT provides private early intervention services and can supplement state-based programs when families need more frequent therapy.

What is the role of caregivers in pediatric physical therapy?

Caregivers play a vital role in pediatric physical therapy. By sharing observations, participating in home programs, and reinforcing therapeutic exercises, parents and caregivers help ensure steady progress and greater carryover of skills into daily life.

Why is school readiness important in pediatric physical therapy?

School readiness programs in pediatric physical therapy focus on improving balance, coordination, and fine motor skills so children can participate confidently in classroom activities. These programs also promote social skills, independence, and confidence, preparing children for successful transitions into group learning settings.

What is Dynamic Movement Intervention (DMI)?

Dynamic Movement Intervention (DMI) is an advanced therapy approach designed for children with neurological or genetic conditions affecting movement. DMI uses guided, repetitive movements and sensory input to promote proper posture, coordination, and strength.

What is gamified rehabilitation in pediatric therapy?

Gamified rehabilitation uses interactive games and Bluetooth-enabled sensors to make therapy sessions fun and motivating for children. At EMpower PT, we use LusioMATE Rehabilitation to track movement and engagement, turning exercises into games like basketball, bowling, and jumpy rabbit.

What is the Schroth Method for scoliosis?

The Schroth Method is a specialized exercise program for scoliosis that helps elongate and de-rotate the spine. It emphasizes breathing techniques, postural awareness, and individualized exercises designed to improve spinal alignment and stability.

How do pediatric physical therapists track progress?

Therapists at EMpower PT perform reassessments every 4–6 weeks to measure your child's progress. We review strength, coordination, and motor skills to adjust goals and celebrate successes, ensuring treatment stays effective and motivating.

What makes EMpower PT’s approach unique?

EMpower PT blends science-based methods with creativity and compassion. Our therapists use play, technology, and family-centered collaboration to make therapy engaging and effective. Each session is customized to your child’s unique needs, ensuring lasting developmental progress.

Understanding Your Child's Toileting Behaviors with Pediatric Pelvic Floor Therapy: Overactive vs. Underactive Bladder

Oct 1

Written By Emily Schlicht

As a parent, it’s common to notice when your child is struggling with bathroom habits. This can look different for everyone – whether it’s frequent accidents, rushing to the toilet, or rarely going at all! While potty training challenges are common, persistent issues may point towards underlying bladder dysfunction that requires attention. Two of the most common bladder patterns seen in young children include overactive bladder and underactive bladder. Understanding the difference between the two plays a key role in getting the right treatment and support.

Overactive Bladder

What is it?

Overactive bladder activity occurs when the bladder muscles (called the detrusor muscle) contract too frequently or when the bladder is not completely full. This can lead to a sudden, intense urge to urinate and lead to accidents if the child can’t reach the bathroom in time. Children may also have difficulty controlling their pelvic floor muscles, which can affect both urine and bowel movements, making it harder to maintain continence and increasing the risk of constipation or incomplete evacuation.

Common signs?

Frequent urination (ex: more than 8x per day)
Urgency – “I have to go RIGHT now”
Urge incontinence – leaking before reaching the toilet
Daytime and/or nighttime accidents
Small volumes of urine with each void

Possible triggers?

Stress or anxiety
Constipation
UTI
Delayed or inconsistent toilet training

Underactive Bladder

What is it?

Underactive bladder activity means the bladder does not empty often enough or completely. Some children may not feel or respond to the urge to go, which can lead to overstretching of the bladder muscles (called the detrusor muscle) over time.

Common signs?

Infrequent urination (ex: 2-3x a day)
Large volumes of urine when they do go
Straining or pushing to urinate
Weak or interrupted urine stream
Dribbling or leaking between bathroom visits
Frequent UTI
Saying they “never have to go to the bathroom”

Possible triggers?

Holding behaviors
Chronic constipation interfering with the bladder signals
Neurological issues (rare)
Delayed or inconsistent toilet training

What will Pediatric Pelvic Floor Physical Therapy include?

Pediatric pelvic floor physical therapy is a non-invasive approach that can help children with both overactive and underactive bladder patterns. Our physical therapists will assess the child's pelvic floor muscles and tailor interventions to their needs. We use age appropriate exercises and behavioral strategies to teach kids how to recognize and control the muscles involved in urination and bowel movements as well as promote healthy bladder habits.

Teaching 'healthy' bladder habits

Our goal is to set your child up for success and healthy habits from a young age. At the start of toilet training, or for children who have tried toilet training with variable success, we recommend timed voiding every 2-3 hours. This encourages regular use of the toilet and avoids overstretching of the bladder and detrusor muscles. Additionally, teaching breathing and mindful techniques to complete before or during voiding encourages relaxation and the mid body connection. Breathing and mindfulness techniques that we often use include 'blowing birthday candles' or 'belly breathing'. We also teach children to sit with their knees bent and feet flat on a support surface. Our therapists will help you identify an appropriate seating system that fits on your regular toilet to promote proper positioning for stress free voiding. Therapy may also include practicing toileting routines in different environments, such as at school or a friend's home, to generalize skills.

Improving pelvic floor muscle strength and coordination

Children with underactive bladders may require pelvic floor muscle strengthening exercises. These exercises may include squishing a stuffed animal between their knees, similarly to a ball squeeze that adults may do at pelvic floor physical therapy. We also commonly have children complete 'open/shut them' exercises, which are similar to clamshells that adults may to at pelvic floor physical therapy.

One of the keystones of our pelvic floor program is the use of biofeedback to give your child live feedback as to how much or how little they are activating their pelvic floor and bladder muscles. This is a non-invasive therapy tool that uses visual and auditory cues to help monitor and guide muscle activity. During biofeedback treatments, adhesive sensors are placed on the abdominal area, allowing children to see how their muscles are working in real time. This helps them learn how to properly coordinate and engage the muscles needed for effective voiding.

Addressing related issues like constipation

Constipation is very common, affecting on average 10-23% of infants through adolescents. Constipation in children is defined as fewer than 2 bowel movements a week, hard/dry/lumpy stools, or difficult/painful to pass stools. It is important to address constipation, not only for comfort, but because if left untreated constipation can result in hemorrhoids and fissures.

Improving Interoception

Interoception is the ability to sense and understand your body's internal state - for example the ability to feel hunger, thirst, bloating, and need to urinate or defecate. Interoception can be more difficult for children with higher or lower tone, children with sensory processing disorders, or children with Autism. Physical therapists are trained to improve interoception in children through physical movement, sensory play, and simple education with repeated patterns and phrases to help children take ownership of their body.

Therapy can help children develop the skill and readiness needed for toilet training success, and parents are encouraged to stay calm and supportive throughout the process. Children with autism spectrum disorder may face unique challenges, and therapy can be adapted to their needs.

Adaptation of Toilet Training Techniques for Children with Autism Spectrum Disorder

Visual supports are a powerful tool in the toilet training process, especially for autistic children or those on the autism spectrum. These supports use pictures, symbols, or visual cues to help a child understand and remember the steps involved in using the toilet. For many children, especially those who benefit from clear, concrete communication, visual supports can make the process of learning new skills like using the toilet much less overwhelming.

Creating a visual schedule for the bathroom routine—such as a series of images showing a child sitting on the toilet, wiping, flushing, and washing hands—can help the child understand what is expected at each step. Placing these visual supports near the toilet or potty chair serves as a helpful reminder and can reduce anxiety about the process.

In addition to step-by-step schedules, other visual supports can enhance the toilet training experience. For example, a visual timer can show the child how long they need to sit comfortably on the toilet seat. Visual charts can also be used to track progress, offering positive reinforcement when the child successfully uses the toilet. This not only encourages desired behaviors but also helps the child see their own growth and achievements.

In Summary

Pediatric physical therapists are well equipped to assist in toilet training children who have an overactive or underactive bladder. We utilize breath work, strengthening, biofeedback, and more to empower your child to take ownership of their toileting habits.

👉 Email us at info@empower.pt.org to schedule an evaluation and give your child the tools they need for a successful toilet training experience.

Emily Schlicht