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Akasha Studio - South Surrey, BC


December 1-2, 2018


This course will be led by Dawn Sandalcidi. Dawn has actively been treating patients for the past 36 years and owns the private practice clinic Physical Therapy Specialists in Centennial, Colorado. She develops educational materials for health care providers and provides consulting services through DSD PT Consulting.



Course Description

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), by 5 years of age, over 90% of children have daytime bladder control. What is life like for the other 10% who experience urinary leakage during the day? Bedwetting is another pediatric issue with significant negative quality of life impact for children and their caregivers, with as much as 30% of 4-year-olds experiencing urinary leakage at night. Children who experience anxiety-causing events may have a higher risk of developing urinary incontinence, and in turn, having incontinence causes significant stress and anxiety for children. (Thibodeau et al., 2013) Having bowel dysfunction such as constipation is also a contributor to urinary leakage or urgency, and with nearly 5% of pediatric office visits occurring for constipation, the need to address these issues is great. (Constipation in Children, 2013) As pediatric bladder and bowel dysfunction can persist into adulthood, pelvic rehabilitation providers must direct attention to the pediatric population to improve the health in our patient populations.

The pediatric population is greatly underserved causing undo stress for the child and family as well as development of internalizing and externalizing psychological behaviors. The two most common pelvic floor dysfunctions in the pediatric population are dysfunctional elimination syndrome and bedwetting. This specialty continuing education course focuses on the treatment of children with day or nighttime incontinence, fecal incontinence, and/or dysfunctional voiding habits.

This course begins with instruction in anatomy, physiology, and in development of normal voiding reflexes and urinary control. The participant will learn terminology from the International Children’s Continence Society, medical evaluation concepts for bowel and bladder dysfunction, and common dysfunctions in voiding and defecation. Common causes of incontinence in the pediatric patient will be covered, and a comprehensive approach to evaluation will be instructed including video examinations of the pelvic floor and surface electromyography (or SEMG, a form of biofeedback) as well as a breathing and bowel massage lab.


Akasha Studio is just off 32nd Avenue and 152nd St in South Surrey. Take 32nd Avenue East from 152nd St, turn right on Croydon Drive, then left on 31st. Look for the brand new SouthPointe99 building on your left as you head south on Croydon.

#101 – 15303 31st Avenue, Surrey BC, Canada 

Objectives & Learning Outcomes

The aim over these 2 days is that by the end you will:

  • List 2 muscles groups and describe 3 functions of the pelvic floor.
  • Understand the development of normal urinary control in pediatrics.
  • Describe the development of the diaphragm as it relates to the PFM.
  • List the 4 phases of defecation and describe the rectal anal inhibitory reflex.
  • Identify common causes of constipation and its’ relationship to bladder dysfunction.
  • Perform visceral and soft tissue techniques for constipation.
  • Describe the pelvic floor relationship to voiding reflexes.
  • Understand pediatric urology terminology and investigative tools used for testing the pediatric patient.
  • Understand pediatric pelvic floor dysfunctions on SEMG as it relates to bowel and bladder function.
  • Evaluate the effects of posture and positioning on pelvic floor muscle recruitment and relaxation.
  • Understand the psychological effects of bedwetting, daytime urinary incontinence and fecal incontinence.
  • Describe behavioral treatments or Urotherapy for pediatric pelvic floor dysfunctions.
  • Understand the use of surface electromyography (SEMG) in the pediatric patient.
  • Develop treatment progressions for children with pediatric bowel and bladder dysfunction.
  • Perform verbal instruction of pelvic floor activation.
  • Perform 3 different diaphragmatic breathing techniques for pediatric patients including diastasis rectus abdominis assessment with examples of core activation.
  • Discuss the effects of toileting postures on pelvic floor muscle recruitment and relaxation.


Day 1

  • 7:30 – Registration
  • 8:00 – Vesicoureteral Reflux- VUR: Definition, medical-surgical management
  • 8:45 – Physiology of defecation
  • 9:15 – Break
  • 9:30 – Constipation and Encopresis: Definitions, treatment, medications
  • 11:00 – Lab- belly breathing with toileting, ILU and connective tissue massage
  • 12:00 – Lunch
  • 1:00 – Enuresis (Bedwetting): Definition, etiology, medical-behavioral management
  • 2:00 – Biofeedback Evaluation & Treatment
  • 3:00 – Break
  • 3:15 – SEMG Demonstration
  • 4:00 – Dysfunctional voiding
  • 5:00 – Adjourn


Day 2

  • 8:00 – Neurogenic Bladder
  • 8:15 – Medical evaluation
  • 8:45 – Psychological considerations
  • 9:30 – Therapy evaluation- subjective and objective
  • 10:15 – Break
  • 10:30 – Therapy assessment, goals & plan
  • 12:00 – Lunch
  • 11:00 – Treatment session examples
  • 11:45 – Bring lunch
  • 12:00 – Eat while watching a complete video initial evaluation
  • 1:00 – Break
  • 1:15 – Lab- belly breathing with PFM descent, defecation with breathing exercises
  • 2:15 – Stimulating a void
  • 2:30 – Startup & referral sources
  • 2:45 – Case Studies
  • 3:45 – Questions and answers
  • 4:00 – Adjourn

* Times are subject to change based on class size and participation

Seminar content is targeted to physical and occupational therapists, physicians and nurses. Content is not intended for use outside the scope of the learner’s license or regulation. Clinical continuing education should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.


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