Abstract
Background and Purpose: Bowel and bladder dysfunction is a common symptom reported by patients following sphincter-preserving operations (SPOs). Pelvic floor rehabilitation is considered an effective treatment of bowel and bladder issues that has high efficacy in the adult population. No studies of this nature have been conducted in the pediatric population after SPO. The purpose of this case report is to describe outcomes of pelvic physical therapy in a pediatric patient with a complex anorectal anomaly and tethered spinal cord requiring SPO and tethered cord repair.
Case Description: The patient was a 15-year-old adolescent boy who presented with bowel and bladder dysfunction. Prior to rehabilitation, surgery for spinal cord de-tethering was being considered. Therapy interventions included myofascial release, surface electromyography (sEMG)/biofeedback, pelvic floor muscle (PFM) exercise, lower extremity stretching, and dietary modification.
Outcomes: This patient reported resolution of bladder emptying, patency of urine stream, urinary urge, constipation, and lower extremity pain. sEMG showed positive changes in both the resting level and values of amplitude during contraction of the PFM. He experienced improvement with perineal and soft-tissue mobility, coordination, timing, and endurance with contraction. Post-void residual was resolved. Concerns related to spinal cord retethering and additional surgery were no longer considered.
Discussion: The outcomes of this case support the evidence provided by previous adult studies that suggest that pelvic floor rehabilitation is an effective treatment in pediatric patients with pelvic floor dysfunction after SPO. Further research is needed to support the effect of pelvic floor rehabilitation in the pediatric population.