The Reconstructive Pelvic Medicine Clinic treats problems with parts of the body in the pelvic area. The pelvic area includes the urinary tract, intestines, anus, rectum, internal sex organs and genitals. Children may have problems with the way these parts work because of how the parts formed before birth or because of an illness or injury that happened later.

Our clinic brings together many healthcare providers who work as a team to diagnose and treat pelvic problems. We combine the knowledge and skills of experts from General Surgery, Gastroenterology, Gynecology, Urology, Adolescent MedicineRadiology and Pathology. Our team approach means your child gets care each step of the way from people who know your child’s full treatment plan. We arrange your clinic visits so your child can see all the providers they need to see in one day, instead of having to make separate visits.

Besides treating your child’s health issues, we understand that pelvic problems can be embarrassing or uncomfortable to deal with. We are careful to take your child’s feelings and needs into account.

Conditions We Treat

  • Healthy intestines squeeze with a wave-like motion to move stool along. Special nerve cells help the intestines make this motion. Children with Hirschsprung disease are missing these nerve cells, so their intestines squeeze shut and stool stops moving forward. Read more.

  • An anorectal malformation is a problem with the way a baby’s anus or rectum formed. The rectum is the end of the large intestine. Stools are stored there until they leave the body as bowel movements. The anus is the opening that stools pass through as they leave the body. Imperforate anus means there is no opening where the anus normally is. Read more.

  • Constipation is common, and most of the time it’s easy to solve at home. But for some children it happens over and over or lasts a long time, and doctors cannot find the cause. Idiopathic means there is no known cause. Even if doctors do not know the cause of your child’s constipation, they can treat it. Often, medicines or enemas are enough. Sometimes surgery is needed.

  • Rectal prolapse means the lining of the rectum sticks out through the opening of the anus. You may be able to see a red mass there. Prolapse is a sign that your child has some other pelvic problem, like constipation, pinworms or an injury. Medicines or other treatments may fix the cause of prolapse. Then the prolapse may get better. If other treatments don’t help, your child may need surgery.

  • Nerves carry signals between your child’s brain and their intestine (bowel) and bladder. If these nerves do not work right, your child may have trouble holding stool or urine in or letting it out when they need to. This problem is called neurogenic bowel and bladder. It is caused by brain and spinal cord problems, like spina bifida or spinal cord injury. Medicines, tubes to empty the bladder (catheters), surgery and other treatments may help.

  • In babies with this birth defect, the pelvic bones are wider apart than normal. Many pelvic organs have not formed in the typical way. The baby’s bladder and part of their intestines are outside the wall of their belly. The intestine may be shorter than normal, and the anus may not be open. The penis in boys and the clitoris and vagina in girls may be divided in two. Often, babies with cloacal extrophy have other birth defects, too, such as spina bifida.

  • Some girls have differences in their vulva (the sex organs outside their body). There may be differences only in the way the organs look or also in how the organs work. In labial hypertrophy, the folds of skin (labia) outside the vagina are larger than what is typical. In imperforate hymen, a thin sheet of tissue partly or completely blocks the opening of the vagina.

  • Girls may be born with no vagina or an incomplete vagina (vaginal agenesis), or their vagina may have formed in a way that isn’t typical (vaginal atresia). Babies with this birth defect often have problems with their uterus and sometimes with other organs. Some have a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Read more about  developmental differences of the vagina (PDF) and about  MRKH syndrome (PDF).

  • A septum in the vagina is a wall of tissue that divides the vagina in two. The septum may go up and down the vagina (longitudinal septum or double vagina), part way or all the way. Or it may go across the vagina (transverse septum), part way or all the way. A double vagina may cause no problems, but it might cause problems with pregnancy. A transverse septum may block the vagina and prevent menstrual bleeding. Read more.

  • The uterus begins as two tubes. These tubes typically join and form one uterus before a girl is born. In some girls the tubes don’t join. Each tube becomes a uterus. Some girls with double uterus also have a divided vagina (one part of the vagina goes to one uterus and the other part of the vagina goes to the other uterus). Read more.

  • Many of a girl’s reproductive organs start out as small structures called müllerian ducts. As a girl develops before birth, these ducts change. They become the girl’s fallopian tubes, uterus and cervix, and the upper end of her vagina. If the ducts do not change in the usual ways, the girl’s reproductive organs may be blocked (obstructed).

  • Bladder exstrophy is a bladder that is not formed right. In most cases, the bladder and genitals are split in half, are turned inside out and sit outside the body. Read more.

Services We Provide

  • Our surgeons are experienced at performing the surgeries children may need to correct or manage pelvic problems. Before we recommend surgery, we explore other treatment options that might help your child. When surgery is the best option, team members work with each other and with you to plan the care your child will need before, during and after their surgery.

  • Most children who get constipated because of problems with pelvic organs can be helped with medicines that start moving their bowels (laxatives) and that soften their stools. When this isn’t enough, we teach children and families how to use medicines, enemas and diet to keep stools moving. We also work with children who can’t keep their bowels from emptying. During a one-week program, our team meets with you and your child. Together we make a plan you can follow at home to keep your child’s bowel clean and prevent accidents. Read more.

  • If your child needs surgery for a problem with their intestines, the surgeon may make a stoma. A stoma is a small opening in the wall of your child’s belly. The surgeon connects your child’s intestine to the stoma so stool can come out of the stoma into a bag. We have nurses who are experts in taking care of stomas. They will teach you how to take care of your child’s stoma at home.

  • An ACE is a type of enema. A surgeon makes an opening in the wall of your child’s belly. Then the surgeon uses a tube (it may be your child’s appendix) to connect the opening to your child’s intestine. You or your child can perform enemas through the tube, instead of through the rectum. If your child will need enemas for a long time (months or years), the ACE method may be easier and help your child be more independent. We do ACE surgery and teach children and families how to use ACE enemas. Read more about  ACE surgery (PDF) and  ACE irrigation (PDF) (using a saltwater solution to flush the bowels and cause a bowel movement).

  • A urinary catheter is a tube that drains urine from your child’s bladder. Your child may need a catheter on a regular basis. The catheter is placed through their normal bladder opening (urethra) or through an opening in their belly (Mitrofanoff channel). This is called clean intermittent catheterization. We will teach you (and your child, if they are old enough) how to do this step by step. Read more.

  • This test helps us learn more about how much your child’s bladder holds (bladder capacity), your child’s ability to hold and empty urine (pee) and your child’s bladder pressures. UDS is done when a child is having a hard time with potty training, accidents (leaking) or infections. At times, this test is done for other reasons, like before certain bladder surgeries. Read more.

  • To “dilate” means to make larger or more open. Vaginal dilation is a method to gently make the vagina wider or longer over time. It’s done by pressing a smooth plastic tube (dilator) into the vagina. This is done for several minutes, usually a few times each day. Dilation may be helpful for a child whose vagina is not complete or not typical. Read more (PDF). 

  • Biofeedback is a method for training your child to better sense and control what happens in their body. It may be helpful for some children who have trouble sensing when they need to release urine or stool. Read more.

  • Having pelvic problems may affect your child’s view of themselves or their body. Children with these problems may feel they are different from other children, or they may have some different needs than most of their peers. They might feel lonely or depressed at times. Our team can help your child cope with feelings and concerns like these.

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