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DOI: 10.1055/a-2536-4328
Evaluating Access and Efficacy of Pelvic Floor Physical Therapy in Pediatric Hirschsprung Disease

Abstract
Background
In patients with Hirschsprung disease (HD), pelvic floor physical therapy (PFPT) is recommended for persistent incontinence or constipation refractory to other treatment, but there are no studies on utilization of PFPT. We aimed to assess clinical and sociodemographic factors associated with successful establishment of PFPT and outcomes following PFPT.
Methods
We performed a single-institution, retrospective chart review of patients with HD referred to PFPT between 2020 and 2023, involving both exercise and biofeedback. Data were collected on clinical factors, sociodemographics, and symptoms before and after PFPT. Those who “saw PFPT,” defined as at least one in-person appointment, were compared to those who did not see PFPT; symptoms were also compared. A p-value of 0.05 was considered significant.
Results
There were 83 patients, of which 37 (44.6%) saw PFPT. There were no differences in age, transition zone, prior interventions, or symptoms. Half of the patients who saw PFPT only completed an initial visit; one-fifth completed the series. Most common reason for failure to see PFPT was scheduling issues. Patients who failed to see PFPT had financial stressors (42.5% vs. 16.1%, p = 0.02) and required formal support systems (28.2% vs. 3.3%, p = 0.02). In patients seeing PFPT, incontinence significantly improved (81.1% before vs. 40.5% after, p = 0.001).
Conclusion
Although PFPT is recommended in children with HD, those with financial stressors or scheduling issues may have barriers to access. However, those who see PFPT have improved symptoms. This suggests a need for improved accessibility of pediatric PFPT to children with HD, such as integration of PFPT into colorectal clinics.
Keywords
aganglionosis - pediatric colorectal surgery - healthcare utilization - Hirschsprung disease - pelvic floor physical therapyPublikationsverlauf
Eingereicht: 30. Mai 2024
Angenommen: 09. Februar 2025
Accepted Manuscript online:
11. Februar 2025
Artikel online veröffentlicht:
27. März 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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References
- 1
Ahmad H,
Levitt MA,
Yacob D.
et al.
Evaluation and management of persistent problems after surgery for Hirschsprung disease
in a child. Curr Gastroenterol Rep 2021; 23 (11) 18
MissingFormLabel
- 2
Ahmad H,
Yacob D,
Halleran DR.
et al.
Evaluation and treatment of the post pull-through Hirschsprung patient who is not
doing well; update for 2022. Semin Pediatr Surg 2022; 31 (02) 151164
MissingFormLabel
- 3
Langer JC,
Rollins MD,
Levitt M.
et al;
American Pediatric Surgical Association Hirschsprung Disease Interest Group.
Guidelines for the management of postoperative obstructive symptoms in children with
Hirschsprung disease. Pediatr Surg Int 2017; 33 (05) 523-526
MissingFormLabel
- 4
Sun X,
Wang R,
Zhang L,
Li D,
Li Y.
Efficacy of pelvic floor muscle training for the treatment of fecal incontinence after
Soave procedure for Hirschsprung disease. Eur J Pediatr Surg 2012; 22 (04) 300-304
MissingFormLabel
- 5
Rao SSC,
Seaton K,
Miller M.
et al.
Randomized controlled trial of biofeedback, sham feedback, and standard therapy for
dyssynergic defecation. Clin Gastroenterol Hepatol 2007; 5 (03) 331-338
MissingFormLabel
- 6
Zar-Kessler C,
Kuo B,
Cole E,
Benedix A,
Belkind-Gerson J.
Benefit of pelvic floor physical therapy in pediatric patients with dyssynergic defecation
constipation. Dig Dis 2019; 37 (06) 478-485
MissingFormLabel
- 7
van Engelenburg-van Lonkhuyzen ML,
Bols EMJ,
Benninga MA,
Verwijs WA,
de Bie RA.
Effectiveness of pelvic physiotherapy in children with functional constipation compared
with standard medical care. Gastroenterology 2017; 152 (01) 82-91
MissingFormLabel
- 8
Ladi-Seyedian SS,
Sharifi-Rad L,
Manouchehri N,
Ashjaei B.
A comparative study of transcutaneous interferential electrical stimulation plus behavioral
therapy and behavioral therapy alone on constipation in postoperative Hirschsprung
disease children. J Pediatr Surg 2017; 52 (01) 177-183
MissingFormLabel
- 9
Muddasani S,
Moe A,
Semmelrock C.
et al.
Physical therapy for fecal incontinence in children with pelvic floor dyssynergia.
J Pediatr 2017; 190: 74-78
MissingFormLabel
- 10
Washington BB,
Raker CA,
Sung VW.
Barriers to pelvic floor physical therapy utilization for treatment of female urinary
incontinence. Am J Obstet Gynecol 2011; 205 (02) 152.e1-152.e9
MissingFormLabel
- 11
Green R,
Mardon AK,
Beaumont T,
Phillips K,
Chalmers KJ.
The accessibility of pelvic health physiotherapy for adolescents with persistent pelvic
pain: a qualitative framework analysis. Physiother Theory Pract 2024; 40 (05) 973-982
MissingFormLabel
- 12
Gala T,
Johnston L,
Solanki D.
et al.
Anorectal manometry—how to perform and interpret manometry. Continence (Amst) 2024;
10: 101214
MissingFormLabel
- 13 Child Opportunity Index (COI) | diversitydatakids.org. Accessed October 31, 2022
at: https://www.diversitydatakids.org/child-opportunity-index
MissingFormLabel
- 14
Smith CA,
Rollins MD,
Durham MM,
Rosen N,
McCracken KA,
Wood RJ.
Speaking the same language in multi-center research: Pediatric Colorectal and Pelvic
Learning Consortium (PCPLC) updated colorectal definitions for 2022. J Pediatr Surg
2023; 58 (05) 1020-1025
MissingFormLabel
- 15
McKenna PH,
Herndon CD,
Connery S,
Ferrer FA.
Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive
computer games. J Urol 1999; 162 (3 Pt 2): 1056-1062 , discussion 1062–1063
MissingFormLabel
- 16
Meinds RJ,
Eggink MC,
Heineman E,
Broens PMA.
Dyssynergic defecation may play an important role in postoperative Hirschsprung's
disease patients with severe persistent constipation: analysis of a case series. J
Pediatr Surg 2014; 49 (10) 1488-1492
MissingFormLabel
- 17
Saadai P,
Trappey AF,
Goldstein AM.
et al;
American Pediatric Surgical Association Hirschsprung Disease Interest Group.
Guidelines for the management of postoperative soiling in children with Hirschsprung
disease. Pediatr Surg Int 2019; 35 (08) 829-834
MissingFormLabel
- 18
Brown HW,
Barnes HC,
Lim A,
Giles DL,
McAchran SE.
Better together: multidisciplinary approach improves adherence to pelvic floor physical
therapy. Int Urogynecol J 2020; 31 (05) 887-893
MissingFormLabel
- 19
Chernoff RG,
Ireys HT,
DeVet KA,
Kim YJA.
A randomized, controlled trial of a community-based support program for families of
children with chronic illness: pediatric outcomes. Arch Pediatr Adolesc Med 2002;
156 (06) 533-539
MissingFormLabel
- 20
Gouin JP,
da Estrela C,
Desmarais K,
Barker ET.
The impact of formal and informal support on health in the context of caregiving stress.
Fam Relat 2016; 65 (01) 191-206
MissingFormLabel
- 21
Weier RC,
Gardner W,
Conkol K,
Pajer K,
Kelleher KJ.
Partners for kids care coordination: lessons from the field. Pediatrics 2017; 139
(Suppl. 02) S109-S116
MissingFormLabel
- 22
Zoorob D,
Higgins M,
Swan K,
Cummings J,
Dominguez S,
Carey E.
Barriers to pelvic floor physical therapy regarding treatment of high-tone pelvic
floor dysfunction. Female Pelvic Med Reconstr Surg 2017; 23 (06) 444-448
MissingFormLabel
- 23
Burgio KL.
Update on behavioral and physical therapies for incontinence and overactive bladder:
the role of pelvic floor muscle training. Curr Urol Rep 2013; 14 (05) 457-464
MissingFormLabel
- 24
Price N,
Dawood R,
Jackson SR.
Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas
2010; 67 (04) 309-315
MissingFormLabel
- 25
Scott KM.
Pelvic floor rehabilitation in the treatment of fecal incontinence. Clin Colon Rectal
Surg 2014; 27 (03) 99-105
MissingFormLabel
- 26
Collins L,
Collis B,
Trajanovska M.
et al.
Quality of life outcomes in children with Hirschsprung disease. J Pediatr Surg 2017;
52 (12) 2006-2010
MissingFormLabel
- 27
Aguirre F,
Heft J,
Yunker A.
Factors associated with nonadherence to pelvic floor physical therapy referral for
the treatment of pelvic pain in women. Phys Ther 2019; 99 (07) 946-952
MissingFormLabel