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USNWR Gastroenterology

 

USNWR Urology

 

There are many areas that overlap when it comes to bladder and bowel issues. These two systems are close together in the body, and the sensory signals your child receives can be confusing since they are sent from similar nerves.

The Center for Integrated Care of Pelvic Dysfunction (CENTIPED) Clinic helps kids with a combination of urinary and gastrointestinal (GI) problems to find a comprehensive treatment plan. Your child might come to this clinic if they have already seen a GI or urology specialist who feels they would benefit from a team approach to their care.

The CENTIPED Clinic is interdisciplinary. That means you will typically see three health care providers at the same time during your appointment:

  • a gastroenterology specialist with expertise in the stomach, intestines and bowels

  • a urology specialist with expertise in the bladder, kidneys and urinary tract

  • a pediatric psychologist with expertise in the behavioral management of medical conditions including elimination disorders (urinary and gastrointestinal problems)

Having an appointment with all three providers at once makes it possible for them to listen carefully to you and your child, do a physical exam, and create a coordinated care plan to address all your child’s needs.

Services

Center for Integrated Care of Pelvic Dysfunction

  • Anorectal manometry for chronic constipation or fecal incontinence – to measure the ability of the muscles in the anus to squeeze and relax

  • Colonic manometry and colonic transit tests for chronic constipation – to measure the ability of the colon to squeeze or move contents from start to finish

  • Bladder scan

  • Pelvic floor therapy – to train voluntary muscles in control of peeing and pooping in order to improve function

Conditions

We care for kids with all kinds of combined bowel and bladder issues, including:

  • Chronic, refractory constipation - long term difficulties with pooping that do not improve with the usual treatments

  • Urinary/fecal voiding dysfunction – difficulty emptying the bladder or bowels

  • Urinary/fecal incontinence - inability to control when the bladder/bowels release

  • Bowel issues that occur along with recurrent UTIs, hydronephrosis, or other bladder and kidney conditions

What to Expect


The CENTIPED Clinic is located in the Surgery Clinic at Children’s Mercy’s Kansas City. You will usually see all three health care providers at the same time when you come for your appointment. They will listen carefully to your child’s symptoms and concerns and do a complete physical exam. You can expect to be at your appointment for approximately one hour.

If you have previously seen a specialist at Children’s Mercy, the clinic team will already have reviewed those records. If you’ve been seen at another provider, please send any imaging studies or records from those visits prior to your appointment.

Your child might need lab work or additional imaging, such as ultrasound, to help the care team make an accurate diagnosis and plan of care. You can often have these studies done the same day at Children’s Mercy.

After meeting with you and discussing all the information that is relevant to your child, the clinic team will share their findings with you and recommend a treatment plan. This may include behavior modifications, medication, physical or occupational therapy for the pelvic floor muscles, or in rare cases, surgery. You will receive a written plan as well, which you can access anytime on the myChildrensMercy Patient Portal.

Helping your child reach long-term bladder and bowel control


Sometimes, when your child has had long-term bowel or bladder issues, it’s hard to get a sense for what is typical or healthy toileting behavior for a child their age. In general, for toilet-trained children, our goal is to help them develop daytime urinary and fecal continence (control over their bladder and bowel), go poop when they want to without straining or pain, and pee every 2-3 hours during the day.

Most children achieve nighttime urinary continence (staying dry at night) between the ages of 5-8, although this varies. Overall, though, 15-20% of children struggle with either daytime or nighttime urinary incontinence, and 2-4% have fecal incontinence, so your child is not alone.

Our goal in the CENTIPED Clinic is to help your child improve their toileting behaviors to what is developmentally appropriate for their age and abilities. It might take some time, but with behavioral and dietary changes, along with medication when appropriate, we expect that we’ll see progress toward achieving continence.

Many children have had success with the help of our caring and dedicated team. Most of all, we want you to know that your child is not the only child with these difficulties and we are committed to helping your family find solutions that work for you.