Infants and children born with colorectal and pelvic conditions very often have related urinary and GI issues that last through childhood and beyond. Taking care of these children mandates pediatric doctors from different specialties, which can be time-consuming and lead to fragmented care. Instead, multidisciplinary teamwork can streamline testing and treatment, avoiding care strategies that may interfere with one another and responding quickly to new developments in a child’s condition. Such multidisciplinary teams dedicated to treating these patients, however, are rare in the U.S.
That’s why Children’s Health℠ launched a new program that brings all the relevant specialists together to collaborate under one roof. The Colorectal and Pelvic Center features experts in pediatric surgery, urology and gastroenterology, working together to provide long-term care for patients with colorectal and pelvic conditions. New in 2021, the center is the only one of its kind in North Texas.
“We want to be a one-stop shop for these kids, taking a multidisciplinary approach to improve the quality of care and the experience of families,” says Erik Hansen, M.D., who directs the Colorectal and Pelvic Center and is a pediatric surgeon at Children’s Health and an associate professor at UT Southwestern.
Complexity that requires coordination
About 1 in 2,500 to 5,000 children are born with an abnormality of their lower intestinal tract or colorectal malformation such as imperforate anus or Hirschsprung’s disease. That translates to about 40 children per year in North Texas, a number that will grow as the population keeps increasing.
Most of these children will need lifesaving surgery right away so they can pass their waste properly, followed by one or more reconstructive operations in the years to come.
“A newborn with imperforate anus, for example, may have a colostomy in an initial procedure. I’ll then reposition the colon and create a permanent anal opening in a future operation,” says Dr. Hansen.
As they grow up, patients born with malformations will also frequently have problems with bowel or bladder management, including incontinence and bedwetting. This may require a variety of urinary and GI treatments ranging from behavior plans to wearable devices, injections and operations.
The ongoing interplay among specialties is a primary reason that the center has been created. Evaluating patients and performing diagnostic procedures as a team allows physicians from different specialties to collaborate on a single, individualized, comprehensive care plan.
“If we’re able to do two surgical procedures, such as a cystoscopy and a colonoscopy, in one anesthesia event, that’s one fewer time the child has to come in for an operation,” says Rinarani Sanghavi, M.D., who is a pediatric gastroenterologist and director of the Neurogastroenterology program at Children’s Health and an associate professor at UT Southwestern.
Building long-term relationships with patients and families
Another benefit to the center’s approach is the long-term relationship it allows between patients and providers.
Problems like incontinence are embarrassing and disruptive for a child and interfere with school and social activities. “On top of that, imagine having to discuss all this uncomfortable information about private parts and bathroom habits every time you’re referred to a new doctor,” Dr. Sanghavi says.
Having a consistent team, on the other hand, builds the trust and comfort families sorely need.
Dr. Sanghavi recalls one patient she treated for more than a decade. As a boy, he was deeply sad and fearful that his incontinence would keep him from dating and having a social life. Last year, he attended his first prom – and he wrote his gastroenterologist to thank her for helping him get there.
“That’s the power of what we do,” she says.
How teamwork improves outcomes for colorectal and pelvic conditions
Linda Baker, M.D., a longtime pediatric urologist at Children’s Health and professor at UT Southwestern, joins Drs. Sanghavi and Hansen as a core provider at the Colorectal and Pelvic Center. They will come together once a month for “clinic days,” reviewing cases together beforehand, seeing six to eight patients throughout the day, and reconvening to collaborate on care plans.
All three have collaborated on cases previously, but never in such a planned and rigorous way.
“Private phone messages, secure emails and hallway chats – we’ll continue doing that as needed but having dedicated time together will be so much more efficient,” says Dr. Baker.
Most patients will be referred to the center either as infants, when reconstructive operations and other follow-up treatments are known to be necessary, or as children, when they suffer unresolved GI or urinary problems. In some cases, the team is brought in when malformations are detected in the womb.
“Then we can plan the whole sequence of treatments from the beginning, with few or no surprises along the way,” says Dr. Baker.
A long-term goal is to provide same-day clinic and procedures. Since families will come from all over the region, having diagnostic tests in the morning and an office visit in the afternoon to review the results and make a plan of care would save them from making multiple trips or staying in Dallas for days between visits.
Finally, the team looks forward to developing new standards of care. Anorectal malformations are rare enough that doctors still have much to learn about how best to sequence and integrate different treatments. Standardization will help the program team and their peers around the country audit, measure and improve care.
Says Dr. Hansen, “These conditions pave a hard road for kids and their families, and we’ll do everything we can to make it easier for them.”
