Wednesday, May 18, 2022

Why a Pediatric Bladder and Bowel PT Encourages Proper Chewing


This is a guest blog post written by Dr. Katharine Cline, DPT from Purple Mountain Physical Therapy.  Purple Mountain PT specializes in treating pelvic floor dysfunction for women, men and kids.  You can learn more about their clinic at or calling (616)516-4334

How Are Constipation and Chewing Issues Related?  

Recently our team of physical therapists had the pleasure of meeting with Building Block Therapy's owner speech language therapist, Courtney Joesel.   We enjoyed discussing some of the common themes that both her team at Building Blocks, offering speech therapy services, and our team at Purple Mountain PT, offering bladder and bowel services, have identified.  Digestion begins in the mouth, where chewing begins and speech therapy focuses.  But it finishes in the gut where nutrition is absorbed and waste is excreted and our physical therapy focuses. 

Is your child struggling with constipation?  Could eating breakfast improve your child's constipation?

Chewing and swallowing play a vital role in regulating digestion, particularly at breakfast time.

I don’t remember the first time I heard “breakfast is the most important meal of the day”, but I know it was in childhood. I’m also sure that in my teen years that comment from my parents was met with an eye roll from me. But, there are many valid reasons parents have been making the argument for breakfast for decades. Let’s investigate how breakfast, and in particular chewing your breakfast, impacts digestion.

Digestion is a complicated process that begins in the mouth.

Proper chewing and swallowing are essential for maintaining a healthy gut and may prevent constipation and other functional gut problems, like irritable bowel syndrome.

If your child is receiving speech therapy services, it is possible that your child may also struggle with constipation.  Not all children who need speech therapy do have constipation, but definitely it is a possibility.  This is because the muscles of the tongue and mouth that help us create speech also are used to help us chew food, which is necessary for healthy digestion.

If you are unable to chew your food properly, then digestion may not be optimal, which can lead to constipation, belly aches or bloating.  Many children experience was is called "A functional gut problem", which means that there is nothing damaged in the tissue of the gut.  This is great news, there's nothing damaged!   But, these kids are experiencing gut problems and often missing school due to abdominal pain or cramping.  Non-functional gut disorders, such as Celiac’s disease or Crohn’s disease, are accompanied by identifiable tissue changes in the digestive tract. Sometimes, when people hear “functional”, they think “not real”. In reality, most gut disorders fall into the functional category.  These issues and their consequences are very real.  Our bowel and bladder program, for both adults and children, is designed to help optimize your pelvic health, which includes resolving constipation, straining and abdominal pain. 

Did you know that Constipation in children is linked to bedwetting, daytime loss of urine and stool?  

Constipation in children does not show up with the exactly the same problems that adults have.  In particular, a child who is constipated is likely to experience nocturnal enuresis (bedwetting), enuresis (daytime bladder leaks), and encopresis (stool leaks or smearing).   When we are working with children to restore their bladder control, we always assess and treat all constipation.   We also notice that children also often experience bloating and abdominal pain when they are constipated.  If you are interested in reading more about childhood bloating, you may enjoy this article we wrote:

In adulthood, constipation tends to manifest as different symptoms.  Most adults do not wet the bed, for example.  But, a constipated adults may experience pain, bloating, hemorrhoids, anal fissures, and increase your likelihood of colon cancer. These problems should be taken seriously. 

What is a Functional Gut Problem?  Could my child, who struggles with chewing and swallowing, have a functional gut problem?  

A functional gut problem indicates that there is discoordination within the digestive system. The various muscles of the gut and your nervous system are not working together correctly. You can think of your digestive system like an assembly line in a factory. In an assembly line, every phase has to be timed correctly and consistently to make a product without backing up the line or slowing production. Disruption at any point in the digestive “assembly line” can lead to uncomfortable bowel symptoms, such as constipation, diarrhea, pain, and bloating.

How Does Chewing and Eating Breakfast Help Improve a Functional Gut Problem? 

Chewing and eating breakfast are like the power switch that turns the whole assembly line on. If you are not chewing and swallowing in the morning your digestion is effectively not getting “turned on” for the day. If there is dysfunction in how you chew and swallow there may be mixed messages going to your gut about whether digestion is on or off!

The Gastrocolic Reflex is your gut's friend!  Take advantage of it by eating breakfast that includes foods that are chewed!

The gastrocolic reflex is activated by chewing in the mouth and stretching of the stomach. It signals the large intestine to begin peristalsis. Peristalsis is the smooth muscle contractions of your gut. Peristalsis moves digestive material through your system. The gastrocolic reflex also helps prepare your rectum for the upcoming bowel movement. This is often accompanied by an urge to defecate. You may have noticed that you are more likely to poop after eating. This is why!

Do most people have a bowel movement in the mornings?  ...Turns out, yes, this is the case!

As humans we are biologically hardwired to have a bowel movement in the morning, typically after our first meal. Giving yourself enough time to eat breakfast and to have a bowel movement in the morning can be essential to prevent a back up in your digestive system. This goes for adults and for children!  And, this also means that you and your child need to learn what the urge to defecate feels like and take yourself to the toilet when this presents.  Ignoring the urge is a bad habit that leads to constipation.  

Don't rush through breakfast.  It takes time to chew and swallow!

If you are rushing through the morning routine and quickly chewing food (or not eating breakfast at all!), then you are not giving yourself enough time to relax, rest, and digest. The morning bowel movement is unlikely to happen.  Parents, if your child is struggling with any bladder control problems or constipation problems, please set their morning up for success by having them eat a breakfast that involves chewing food and also having enough time afterwards to use your toilet to defecate when they experience an urge!  

What happens if I don't have my morning bowel movement?  Well, stool gets backed up.

If you don't have access to the toilet, because you are commuting to school or because school rules prohibit unscheduled bathroom breaks, you may miss your opportunity to defecate.  The urge will go away, often until tomorrow morning.  Without a morning bowel movement, stool remains in your rectum for a longer period of time. More stool may accumulate as your day progresses This means that when a bowel movement does happen, your rectum may not empty completely, may contain a larger stool that requires straining, or the stool may become hard and pebble-like. All of these symptoms can indicate constipation.  

Quite often our patients do not empty their rectum completely!  This is very common in the children we treat.  

Even if you are having bowel movements daily, if your rectum is not emptying completely, then you are constipated. 

This is especially true in children. In children, the rectum is more easily stretched as kiddos are still growing and developing. As mentioned before, when kids are constipated and have a stretched rectum it can lead to other issues with bedwetting (nocturnal enuresis), daytime urinary incontinence (enuresis), and fecal smearing or fecal leaks (encopresis). 

Taking time to eat breakfast, chew your food and use the toilet when you experience an urge is one of the most important things you can do to help your child's constipation.  

 You and your child might be surprised what adding just a few more minutes to your morning routine can do for your doo-doo.  

The Autonomic Nervous System also influences digestion! 

When we think of promoting chewing, swallowing, healthy digestion and preventing constipation it is also crucial to think of your autonomic nervous system. Your autonomic nervous system is “automatic” meaning it’s the part of your nervous system that you aren’t necessarily aware of. Throughout the day you don’t have to think “stomach start to churn” “small intestine keep working”, etc. This is the brain-gut connection which is now being investigated for it’s impact on mental health, the immune system, and more. How do we influence something we are not consciously aware of? Good question!

The Fight or Flight Nervous System

You may have heard your autonomic nervous system described before as having two components sympathetic and parasympathetic. The sympathetic nervous system is responsible for the “fight or flight” response which includes sweating, elevated heart rate, heightened arousal, and blood rushing to the muscles in your legs and arms. It primes your body to escape from a threat.  

The Rest and Digest Nervous System

The parasympathetic nervous system is responsible for the “rest and digest'' response. When the parasympathetic nervous system is more active, then your heart rate slows, breathing deepens, blood returns to the digestive tract, and you feel more relaxed. It is crucial for healthy digestion that the parasympathetic and sympathetic nervous systems be in balance.

Stress causes your rest and digest  nervous system to not be activated.  This is another reason why the “morning rush” can be detrimental to the morning bowel movement and increase the likelihood of a functional gut problem.

Heart rate, blood pressure, breathing rate, and sweat are all indicators of how active and/or balanced your sympathetic or parasympathetic nervous systems are.

When your heart is racing, you have sweaty palms, and you’re breathing quickly your sympathetic nervous system is in the driver’s seat. When you are taking deep breaths and have a low heart rate, then your parasympathetic nervous system is more in the driver’s seat. This state is also what supports healthy digestion. It is very beneficial for your gut to be in a relaxed headspace while you are eating.

The Vagus Nerve is Stimulated when you chew!  Isn't it cool that using your mouth can help your digestion?  

Your path to helping your sympathetic and parasympathetic nervous systems remain balanced is through the vagus nerve. The vagus nerve is a main regulator of your parasympathetic nervous system. It is also referred to as your 10th cranial nerve. Its path is long and wandering. It extends from the brainstem to the neck, thorax, and down to the abdomen. The vagus nerve controls most of the muscles in the pharynx and larynx required for swallowing and vocalization. In this way, the vagus nerve impacts gut function from the very moment food enters your mouth! 

Improving Vagus Nerve activation is one thing that has been studied to help improve people's stress response.  The Vagus Nerve essentially calms us down and, in so doing, can help our digestion to improve.  A recent report out of Harvard Medical School highlighted that chewing gum stimulates the Vagus Nerve.  They are even suggesting that giving gum to patients post-operatively can be helpful to stimulate bowel activity.   

How Boxed Breathing Practice Can Improve Vagus Nerve Activity.  

Wondering if your vagus nerve is active? The vagus nerve also plays a critical role in controlling heart rate and respiratory rate. You can help improve the activity or tone of your vagus nerve through controlled breathing exercises. One example of this is a boxed breathing technique.  In this method of breathing you will:

Inhale over the course of 4 seconds,

Hold your inhale for 4 seconds,

Exhale for 4 seconds,

Hold your exhale for 4 seconds.

Repeat this for several rounds can help stimulate your vagus nerve, improve your parasympathetic drive, and therefore your digestion!

Is Your Speech Therapist working on your Posture?  Chances are Yes!  Well, your bladder and bowel physical therapist will also work on Posture! 

A healthy gut requires good coordination throughout the digestive tract. This means healthy swallowing, healthy nervous system, healthy breathing, and a healthy pelvic floor. Posture plays an essential role in all of these functions. For example, a slouched posture places the muscles of chewing and swallowing on stretch, restricts the motion of the diaphragm, impairs muscle activation in the core, and contributes to tension in the pelvic floor. Maintaining an active lifestyle with both intentional movement (exercise) and unstructured active play is one of the best ways to help prevent issues with posture and promote a healthy gut!

Pelvic PTs are Always Talking to Our Patients About Constipation and Chewing Because they are Crucial to Bowel and Bladder Health.  

There are strong ties between chewing and swallowing and overall digestive health. Taking time to eat in the morning, to breathe with the diaphragm, to exercise, and to play are essential for a healthy gut and a healthy life! Remember functional gut problems like irritable bowel syndrome and many forms of constipation are real health problems with significant health impacts. They should be taken seriously and there is help.

Purple Mountain Physical Therapy is a specialty PT clinic located in Grand Rapids, Michigan.  We treat women, men and kids who have bladder, bowel and pain conditions.  Our specialty pediatric PT program improves kids' self esteem, capacity to control their bladder and bowels and sets them up for lifelong good habits for bladder and bowel care.  We are trained in pediatric specific and developmentally appropriate interventions that are positive, play based and help a child learn the complicated process of controlling their bladder and bowel muscles.  Quite often the adults we treat tell us that their bladder problems developed back in childhood.  It is our mission to reduce childhood embarrassment related to toileting challenges and to help ease stress amongst parents who so often worry their child may be made fun of by other kids.  If you are interested in learning more about our bladder & bowel programs you can check us out at  or call our office at (616)516-4334

Dr. Katharine Cline, DPT is a pelvic health physical therapist who treats adults and kids.  She enjoys working with children and their parents to help empower kids to enhance their bladder and bowel control and to improve their self-esteem while doing so!  Her greatest reward is a smiling and talkative child who expresses happiness over their "wins" related to bladder and bowel control.  Parents often tell us this physical therapy has eased stress and laundry in the home!   

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