26. Constipation, Urinary Incontinence, and Picky Eating with Quiara Smith MOT OTR/L of Aloha Integrative Therapy
Join Brittyn as she interviews Quiara Smith, a pediatric pelvic health occupational therapist. Learn about how a pelvic health occupational therapist can help a child with toileting challenges. During this episode Quiara and Brittyn discuss the connection between the pelvic floor and issues such as urinary incontinence, constipation, and picky eating.
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IN THIS EPISODE
Learn what conditions a pelvic floor therapist treats.
Understand how the pelvic floor impacts the toileting patterns of children with sensory dysfunction.
The connection between the pelvic floor and urinary incontinence, constipation, and picky eating.
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Transcript
Welcome to the Nourishing Autism Podcast where you take a deep dive into the research on autism and dietary changes, nutrition supplements, and lifestyle modifications. Every week, we break down nutrition topics and an easy-to-understand way for you to feel less overwhelmed and feel confident on your nutrition journey with autism.
Brittyn: Hi everyone and welcome to the Nourishing Autism podcast. For today's episode, I interviewed Quiara Smith, who is a pediatric pelvic health occupational therapist. If you're like me, I had no idea that there was such a thing as a pelvic floor therapist for kids. But Quiara and I first connected on Instagram and I've learned so much from her about toileting challenges and the connection between urinary incontinence and constipation for my clients. I referred many clients to her with great success and just believe that she has so much information to share so I hope you enjoy this conversation between the two of us looking at both sides of [00:01:00] constipation from the occupational side and the nutrition side. I think you'll gain a lot of information from it.
Today I am so excited to have Quiara Smith on the podcast. Quiara, thanks for being here.
Quiara: Thanks so much for having me.
Brittyn: I would love for you to tell us a little bit about yourself and how you serve your clients, because I loved learning all about your approach is so unique and so helpful to many of my clients too.
Quiara: Yeah. So my name is Quiara Smith. I'm a pediatric pelvic health occupational therapist. And that means that I exclusively treat children who have bowel and bladder dysfunction and toileting challenges. I am located in West Fargo, North Dakota. I just moved here in the summer. So in the dead of winter now, which is very different than the summer.
But I have a clinic here in West Fargo that I serve clients as well as providing telehealth services to people all over the world. And just really, I'm excited to [00:02:00] be sharing this information with all of your listeners today.
Brittyn: Amazing. And I love that you offer telehealth because that just allows such a greater reach. I do tele-health, tele-health too and it's made such a huge difference in my practice and can reach so many more people. So I think that's so awesome. So for those people who may not know what pelvic floor therapy is, would you mind explaining that?
And then we're going to talk a little bit about the difference in kids versus adults, but you can start with the basics there.
Quiara: Yeah. So pelvic health therapy is, or pelvic floor therapy is what other people call it is basically a non-invasive approach that's based in evidence and research. And basically what it looks at is how are the pelvic floor muscles working in relation to toileting skills. And so oftentimes a lot of the kiddos that come to see me, they have challenges with coordinating the pelvic floor or having two weak or two strong pelvic floor muscles. And [00:03:00] yes, there is too strong pelvic floor muscles, meaning kids have that tight kind of tone in their muscles because they're withholding and that causes the pelvic floor not to be able to relax when they need to relax and void.
And so that's kind of what a pelvic floor therapist does, looks at that system as well as understanding the urinary and digestive system of a child, because children are not mini adults. I always say this I'm in a lot of the talks I give and my client treatment sessions is we have to look at the child where they are developmentally.
And so a big focus for my practice is looking at the child's sensory system and looking at their developmental level and looking at how are they in their body and experiencing the world because oftentimes this is impacting their toileting skills.
Brittyn: Very true. And this may seem like a really basic question, but can you tell us what the [00:04:00] pelvic floor is? I feel like that's such a it almost, I see it everywhere, especially with my colleagues who work in pregnancy. And I think a lot of people just don't even know what the pelvic floor is.
Quiara: Yeah. You kind of hear this buzzword pelvic floor, especially when you're looking at women's health postpartum care and basically the pelvic floor everyone has it, whether you're a male or female, it is a group of muscles that are hammock like in structure. And they are basically the muscles that keep our internal organs supported.
And there's a lot of function of the pelvic floor, but for our talk today, we'll discuss how they are basically the gatekeepers of how children void. Are they able to relax and have that gate open? Are they able to contract and keep that gate closed at certain times? And so we want to hold when we need to hold at certain times and relax and let go when we need to [00:05:00] void pee or poop.
And so the pelvic floor muscles play a really important role in that function.
Brittyn: That's so helpful to know. And just like you said, with pregnancy and postpartum women's health. I mean, it's such, it is a buzz word and protecting your pelvic floor and making sure that your pelvic floor muscles are strong. It's just such an interesting area that I wasn't aware of until the past few years.
And then, especially with. I've just learned how incredibly important that is because so many kids struggle with constipation or urinary incontinence. And in my area I am thinking of, okay, what is the gut microbiome look like? And how is that causing constipation or what what amount of fiber are they getting in their diet?
Are they a selective eater? And all of those are incredibly important and need to be addressed in order to have healthy bowel movements, but there's also this other side, which just really opened my eyes when I started learning from you that people can be doing all the right things with nutrition and then still have [00:06:00] constipation still have these issues due to pelvic floor issues.
Quiara: Absolutely. And I love that you're highlighting. They can do everything under the sun, with their nutrition, with managing maybe anxiety and with good habits, meaning they're sitting on the toilet, they're having their water, they're not resisting, but still there's that missing piece. And then this is where pelvic floor therapy can actually be that missing link and missing piece to the puzzle because the muscles aren't being coordinated correctly.
Or like I mentioned before, they're maybe too tight, too weak, a combination of both. And that's kind of where our bread and butter is as special providers for the pelvic floor.
Brittyn: So, what does that look like to do public floor therapy in children? Versus what it typically looks like to do pelvic floor therapy in adults.
Quiara: I love that you asked me that question because a lot of people think that it's an very invasive, internal exam type of procedure process. [00:07:00] And I want to say that's absolutely not true. For children, we don't do any internal examination, so no vaginal or rectal examinations, we basically do an external examination, a visual inspection of maybe the perineal area.
Just looking at if there's skin breakdown, especially kids who or are soiling or having fecal or urine leaks, oftentimes that they have significant skin breakdown. And then we also see how the pelvic floor muscles are working on externally by having kids squeeze and relax, showing us how that kind of muscle activity is working for them.
And by that examination, we can, you know, deduce is the child releasing when they should be, or is the child holding when they shouldn't be. And oftentimes this is the case with kids is that they're not really tapped into that coordination, or they're not really aware of how they're using their body in that way.
Brittyn: I think that's [00:08:00] huge too. I see a lot of kids who might not have that full connection in between what is my body feeling right now? Do I have the urge to go to the bathroom? So I'm going to ask you more about that later. But, there's so many, I mean, typically we're thinking about constipation with pelvic floor and incontinence, of course.
But this can also impact picky eating and I'll chime in here too, but I would love to hear different, basically, how all of these are connected and what you see in your clients.
Quiara: Yeah. So in my holistic approach, I'm looking at all different kind of functions in area of the child and the association I see between constipation, picky, eating and sensory differences is that they are all interconnected. Meaning when a child is constipated, their bowels are full and this has an effect on appetite.
Meaning when you're full of poop, you're not necessarily hungry. And then you add on top of it, maybe that child at baseline is under- responsive to urge [00:09:00] sensations of what what hunger feels like or what thirst feels like. And then you add on top of it, maybe a baseline kind of difference of feeling pee or poop is my bladder full?
Is my rectum full? Is it empty? And so these kiddos are we have to do a little bit more detective work because then this can impact the ability to try different foods or want to eat different foods. And so I can go on and on and on about the sensory system, because it's such a complex and wonderful topic to talk about.
But just to keep it brief, is that when someone is having, you know, the constipation plus the picky eating and they're eating foods that are binding or constipating anyway, you're going to then affect how that child is going to stool, meaning that their stool is hard and heavier. So that's putting a lot of pressure on the pelvic floor.
So the pelvic floor has to squeeze and hold that. Remember we talked about those gates and so we have to keep [00:10:00] those closed. And if that is happening constantly day in and day out, moment to moment that puts a lot of stress and strain on the system. And then you add picky eating and the nervous system already is in an anxious state or a fight or flight state when we're expecting this child to eat these foods that are not safe for them.
And then go to the bathroom when they're feeling anxious and nervous anyway. So it's kind of this cascade and snowball effect that we get. So it's really looking at each system and saying, Hey, you know, myself as a pelvic floor therapist, I know this area and I can support a child in a family this way. And then you Brittyn, you are, you know, a wonderful expert in dietetics and, you know nutrition and food. And so that's that area that you can work on. And so having all these different areas where different providers can really infuse their expertise and knowledge for that child is what's going to help them move forward with the process of, you know, getting [00:11:00] nutrition they need, being able to go to the bathroom, not withholding, not having constipation and all these things.
Brittyn: I completely agree with you. I also agree with that snowball effect. And we see that so much in constipation and then picky eating and what we noticed, you know, like you said, when kids are severely constipated, then they're not hungry. And then they eat a very little amount of food and probably very little amount of fiber because what you're wanting to eat when you feel yucky and your tummy feels really heavy is something that's probably pretty crunchy or maybe void of many nutrients that are going to maybe give you some of those sensory, that sensory feedback too. And so I see then kids aren't getting a fiber and then it causes the constipation to be worse, and then they're not getting all of these vitamins and minerals, which are incredibly important for gut function.
And so it just cascades, just like you said. And and so a lot of people want to start with the picky eating. But a lot of times you actually have to start with the gut in order to open up the doors for picky eating. So and I completely [00:12:00] agree. Oftentimes you have to look at, look at it from multiple sides before you really get to all those little pieces that are going to be the answer for a child.
Quiara: Yeah. And I always tell my clients, I wish I can give you this magic pill or this magic you know, process to follow. And you're gonna meet your goal in a week or two weeks, but it just doesn't happen like that. And that's the frustrating thing for parents. And the overwhelming thing is they feel that they're doing everything that they possibly can, or that they've learned about and still there's no change. And I want to say, this is the reality for a lot of the clients that you know, you and I work with. But there is a process by which I think families can feel good and supported with experts who know, and who have worked with these types of population of kiddos. And that's really where I think most of the change is [00:13:00] going to happen.
When you have that team of experts really supporting your child and your family.
Brittyn: So true that it's so incredibly true. So my last question that I have for you, if kids aren't feeling the urge to go to the bathroom, how do we get them to feel that urge. A lot of people ask me this in terms of like getting them to pass that really hard bowel movement. And in terms of eating, there are some tips that I have, and I've talked about a little bit on Instagram, but I would love to hear like some of the approaches that you walk families through to help with this.
Quiara: Yeah. So the sensory system that's responsible for the feeling of urge. Like I mentioned before, like with the feeling of being hungry or thirsty, having the urge to go to the bathroom, this is the interoception system and it's the system that is not yet well-researched, but there's research that is going on currently to support that this system really needs to get integrated more in [00:14:00] individuals to be able to function more efficiently in all different aspects of life and all different tasks that a person can engage in. And so the interoception system is really important because like I mentioned, in my previous example, some kids are under responsive, meaning that they are not feeling the sense to go to the bathroom like their peers. And so this system really needs to be integrated from the outside in first. And so interoception is from an inside out approach. But first we need to make sure that the child is in their body, meaning that their tactile system is getting stimulation, that their auditory system, their visual system, their ability to move their body through space.
All these things need to be foundational before they can really tap into that internal sensation and it's kind of abstract I know, but it's really [00:15:00] understanding how, if you can't feel where your body is or how it's being used, you're not going to be able to feel the internal sensations more. And we work on that by association.
So when an example is working on the tactile system, I'm going to put my hands under water and I'm going to have the cold water on with a child. And we're going to do hand washing because hand washing is huge these days with COVID, but also too with just proper hand hygiene in general. And so we're going to talk about, oh, how does that feel on our hands?
I can talk about temperature. Oh, that feels kind of a cold Ms. Quiara. Oh, that feels warm. That feels slippery. So it's having these associations where the brain and the body start to say, okay, I understand that that is that type of sensation and it's making those connections stronger. And so hopefully what happens is over those practice repetitions that the sensory system starts to get more [00:16:00] imbalanced is what I like to call it. And then we start to understand, huh? When I feel like I have to go to the bathroom, instead of feeling it, some kids tell me they feel it in their chest, that they have to pee that necessarily isn't where we would anticipate to feel that we have to urinate.
And so after we do sensory integration activities, maybe it's been a couple of weeks and that feeling from the chest starts to move down into their stomach. Now it starts to move down into the, into the bladder area, which is where we want to feel it. And so this is kind of the process by which we work on that system.
Brittyn: That's so interesting. And the way you explain that makes total sense. A lot of times in picky eating and helping kids recognize hunger cues I have parents start with a very, very routine mealtime and snack schedule and that way we're not grazing all day, because when we're grazing all day, we don't ever recognize that we're hungry because we're probably not.
So when we start with breakfast, lunch, snack, lunch, or sorry, breakfast, snack, [00:17:00] lunch, snack. Then it helps the kids in between those times also recognize some of those internal signals. Oh and maybe I'm hungry or their stomach starts saying, okay, it's lunchtime I'm starting to get hungry now that even helps with digestion.
So And the way that you explained it putting some supports in place, helping kids recognize and walking them through the steps, I think is so incredibly important. And I just hadn't thought of it in the way that you had said that. But in fact, practice a very similar approach of course, a different field, but you're right.
I mean, it is inside out, but sometimes you have to start outside in.
Quiara: Yeah. And it's a really wonderful thing to start to role model. Right? So for families that come to see me, I say, when you have the urge, you should start saying how your body is feeling in front of your child. So it would be like, maybe you're sitting down and you're watching TV and you're saying, oh my goodness, Brittyn, I think my body's telling me I have to go to the bathroom.
I'm feeling like I need to pee right here in my bladder [00:18:00] pointing and showing and saying what does it feel like? Well, it feels kind of like someone's maybe pressing or giving me a little hug down there. I think I need to go to the bathroom now. So you're giving words in association to a body feeling that you're having to give your child examples of what that potentially could be.
And I love that you say about the schedules, because that's exactly what I do in my practice is we have waiting schedules because some of the children that land in my care do not feel urged to go to the bathroom. So we have to make sure that we know their body patterns to be able to integrate those sit times to where that bladder empties or when that rectum empties.
And so that starts to make them habituate or understand, oh, I know I can't go past four hours. Cause we know in evidence based practice, you cannot, you should not have your bladder being held past three hours for children. And so we know, okay, I know that I need to [00:19:00] sit and I need to empty because my bladder is going to be full at that point.
Brittyn: That's so important. A lot of times on a small scale with kids who are struggling with constipation, I'll also talk about how can we coordinate, like going like a toileting schedule around the food we're eating too, because what happens when you're chewing and swallowing, you have that personal assist that's happening in your soft vagus, but that's also happening throughout your small and large intestine as well.
So it's moving things. Pushing things down. So a lot of times I'll recommend, you know, how about after we eat a meal, we sit down and see if we can go to the bathroom. Cause that makes it easier on our body. It's already starting to do that work. So I'm sure you would have a lot more to say about that. But when, when parents have that initial concern that they notice their children or child, isn't going every day a lot of times that simple approach they'll start to notice progress because their child just wasn't recognizing that they needed to go. And sometimes having that really. regimented schedule around food and toileting can be really helpful.
Quiara: Yeah, absolutely.[00:20:00]
Brittyn: Well I know after the, this podcast, a lot of people are going to wonder where they can get in contact with you or how they can work with you.
So I'd love for you to share that and where people can find you.
Quiara: Yeah, so people can find me at alohaintegrativetherapy.com. That's my website. And you can also follow me on social media. I share lots of tips and tricks about how to support your child, who is struggling with some of the things we discussed here today in this podcast. And that's at @alohaintegrativetherapy.
And like I mentioned before we offer telehealth services that looks like parent coaching. So being able to coach you through what's going on with your kiddo and that's international clients as well. And then if you're local to North Dakota and you're listening to this, you can come in and see me and my facility dog Nellie, in our wonderful clinic here in West Fargo, where you would work one-on-one with me and my boutique practice.
Brittyn: That's incredible. Well, hopefully [00:21:00] people can connect with you. I mean, the way we connected with it was Instagram. So you provide really great posts and information to help families, even just looking over your posts. So thanks so much for being here Quiara, I know people will gain a lot from what you had to say today.
Quiara: Well, thank you so much for having me. I really appreciate that.
Brittyn: Yeah. Thanks. And thanks everyone for listening. We'll see you next week.
This podcast is brought to you by the Autism Nutrition Library, a one-stop hub and community for all things autism nutrition created to help you explore evidence-based nutrition approaches that have proved to be effective to help individuals with autism feel their best, do their best, and be their best.
Join now by clicking Autism Nutrition Library or by stopping by my Instagram @AutismDietitian. See you next week.
Transcribed by Descript
ABOUT Brittyn Coleman, MS, RDN/LD, CLT
I’m a Registered Dietitian, Autism Nutrition Expert, and the Creator of the Autism Nutrition Library.
I work with parents of children with autism to optimize their child’s diet, supplements, and lifestyle based on their unique needs. I help expand accepted foods for picky eaters, improve digestion and gut health, find the root causes of many symptoms, and ultimately help them feel their best so that they can do their best and be their best.
Not only do I relate to families on a professional level, but also on a personal level. I have been a part of the autism community for over 20 years, as my younger brother was diagnosed on the spectrum at a young age.
I look forward to working with you to uncover the root cause of your child’s symptoms and help your child be the best version of themselves!
