Benefit of Pelvic Floor Physical Therapy in Pediatric Patients with Dyssynergic Defecation Constipation

Dig Dis. 2019;37(6):478-485. doi: 10.1159/000500121. Epub 2019 May 16.


Objectives: Chronic constipation is a common childhood problem and often caused or worsened by abnormal dynamics of defecation. The aim of this study was to assess the benefit of pelvic floor physical therapy (PFPT), a novel treatment in pediatrics for the treatment of chronic constipation with dyssynergic defecation.

Methods: This was a retrospective study of 69 children seen at a pediatric neurogastroenterology program of a large tertiary referral center for chronic constipation and dyssynergic defecation, determined by anorectal manometry and balloon expulsion testing. We compared the clinical outcome of patients who underwent PFPT (n = 49) to control patients (n = 20) whom received only medical treatment (laxatives/stool softeners). Additionally, characteristics of the treatment group were analyzed in relation to therapeutic response.

Results: Thirty-seven (76%) of the patients who received physical therapy had improvement in constipation symptoms, compared to 5 (25%) of the patients on conservative treatment (p < 0.01). Additionally, patients who received pelvic physical therapy had fewer hospitalizations for cleanouts (4 vs. 25%, p = 0.01) and -colonic surgery than those that were treated with medical therapy exclusively (0 vs. 10%, p = 0.03). Among the patients who received physical therapy, those that suffered from anxiety and/or low muscle tone had a higher response rate (100%). There were no adverse effects from the intervention.

Conclusion: The new field of pediatric PFPT is a safe and effective intervention for children with dyssynergic defecation causing or contributing to chronic constipation, particularly in children whose comorbidities include anxiety and low -muscle tone.

Keywords: Anal canal; Fecal incontinence; Manometry; Physiotherapy; Surface electromyography.

MeSH terms

  • Adolescent
  • Anal Canal / physiopathology
  • Ataxia / complications
  • Ataxia / physiopathology*
  • Child
  • Child, Preschool
  • Constipation / complications
  • Constipation / physiopathology*
  • Constipation / therapy*
  • Defecation*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Manometry
  • Pelvic Floor / physiopathology*
  • Physical Therapy Modalities*
  • Rectum / physiopathology
  • Retrospective Studies
  • Treatment Outcome