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Evaluating Access and Efficacy of Pelvic Floor Physical Therapy in Pediatric Hirschsprung Disease
Shruthi Srinivas1, Sarah Driesbach1, Madeline Su2
1Nationwide Children's Hospital, Center for Colorectal and Pelvic Reconstruction, Columbus, Ohio, United States.
Insights
Pelvic floor physical therapy (PFPT) for Hirschsprung disease (HD) shows improved incontinence, but access barriers like financial stressors and scheduling issues hinder utilization. Improving PFPT accessibility is crucial for these patients.
Area of Science:
- Pediatric Gastroenterology
- Physical Therapy
- Colorectal Surgery
Background:
- Pelvic floor physical therapy (PFPT) is recommended for persistent symptoms in Hirschsprung disease (HD).
- Utilization and outcomes of PFPT in pediatric HD patients are not well-studied.
Purpose of the Study:
- To assess factors associated with PFPT establishment in HD patients.
- To evaluate clinical and sociodemographic outcomes following PFPT.
Main Methods:
- Retrospective chart review of 83 HD patients referred to PFPT (2020-2023).
- Compared patients who attended at least one PFPT session versus those who did not.
- Analyzed clinical, sociodemographic data, and symptom changes before and after PFPT.
Main Results:
- 37% of patients attended at least one PFPT session; many did not complete the series.
- Financial stressors and need for formal support systems were barriers to PFPT attendance.
- Patients attending PFPT showed significant improvement in incontinence (81.1% to 40.5%).
Conclusions:
- While PFPT improves symptoms in HD patients, access barriers exist.
- Strategies to improve pediatric PFPT accessibility, like clinic integration, are needed for HD patients.
Abstract:
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.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.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).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.
