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 with PFPT and outcomes following PFPT. Methods We performed a single-institution, retrospective chart review of patients with HD referred to PFPT between 2020 - 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; symptomst 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 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 While 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.