Giving Hope to Patients with Pelvic Problems, a New Multidisciplinary Approach

Dr.AvansinoBethanyChurchSometimes, everyday moments can have the most profound impact on an individual’s life. For Dr. Jeffrey Avansino, a surgeon at Seattle Children’s Hospital, that moment came many years ago as a new attending physician. An appointment with an 8-year-old girl changed his path as a doctor and inspired him to become a national leader in reconstructive pelvic medicine.

“There needed to be a better way”

“I walked into the exam room not really knowing what to expect,” said Avansino. “The little girl I was seeing that day had fecal incontinence and had previously undergone surgery to repair an anorectal malformation.”

For most of the appointment she hid behind her mother, not wanting to talk. She was socially withdrawn, and her mother explained that she was having trouble concentrating at school. Avansino learned from their discussion that she had been going to school in diapers. She wasn’t able to control her bowels and would have accidents throughout the school day.

“I was shocked,” said Avansino. “I knew I needed to do something to help, but also I couldn’t manage patients like her on an individual level.”

A unique clinic to treat unique patients

Most children with pelvic problems have very complex issues and need to be seen by many different specialists. Avansino knew he would need to combine the expertise of many providers into one multidisciplinary clinic in order to better treat kids and adolescents with pelvic problems, so he spearheaded the Reconstructive Pelvic Medicine Clinic at Seattle Children’s Hospital – one of only a few clinics of its kind in the country, and the only program on the West Coast.

“By creating a truly unique, multi-disciplinary clinic, we are able to deliver the best care for each patient,” said Avansino. “We tailor treatment for each child; it’s not only more effective, but it makes the care we provide better.”

Instead of scheduling multiple visits to the hospital, Seattle Children’s Reconstructive Pelvic Medicine Clinic arranges appointments for children to be seen by multiple providers from various specialities all in one day. By combining the knowledge and skills of experts from pediatric surgery, gastroenterology, gynecology, urology, adolescent medicine, radiology and pathology, the clinic allows children to receive care that focuses not only on their medical needs, but also on improving a child’s quality of life.

Pediatric motility program

Seattle Children’s is also the only hospital in the Pacific Northwest that offers a pediatric gastrointestinal motility program, which works closely with the Reconstructive Pelvic Medicine Clinic. Led by Dr. Lusine Ambartsumyan, a board-certified pediatric gastroenterologist, she has special training and expertise in the study of nerves and muscles of the intestine that move food and waste through the body. Abnormalities in motility are common in children with anorectal malformations, spinal cord abnormalities, intractable constipation, and post-surgical Hirschsprung disease amongst others.

“We study the physiology of the intestine, specifically how the muscles and the nerves of the intestine work, from the mouth to the anus,” said Ambartsumyan.

In a healthy child or teen, the nerves and muscles of the digestive tract work together to move food through the body and expel waste; unfortunately, in children and teens with motility issues, the nerves and muscles don’t work properly and can cause serious issues. That’s when Ambartsumyan steps in to help.

From achalasia, problems with muscles in the lower part of the esophagus, to anorectal malformations, the motility program works with families to create an individualized treatment plan to manage their specific motility disorder.

“In the past, when children with and without organic disease had fecal incontinence, they used to be labeled with a psychiatric disorder. Today, we understand that’s just not the case and the problem is multifactorial,” said Ambartsumyan. “Every patient has a specific treatment plan based on the specific physiological properties of their intestine and their symptoms. We don’t just follow a treatment algorithm. We meet with every patient with the goal of ultimately improving their quality of life. It’s our job to help the kids and parents who feel they’ve run out of options, to give them hope, and to provide a light at the end of the tunnel.”

Finding the right care, at the right time

20140721_135857 (2)Bethany Church and her family were running out of options. They had been to what seemed like every hospital in their home state of Oregon before they decided to explore other options.

“We were fed up. We started proactively looking for other treatments for Bethany,” said Richard Church, Bethany’s father. “We needed to advocate for Bethany to improve her quality of life.”

Bethany, 7, was born with an imperforate anus, without an opening at the end of her digestive tract. For Bethany, her condition causes her to have problems controlling her bowel movements and causes stool to build up in her digestive tract, which can be painful.

The Church family was eventually referred to Seattle Children’s.

“Since meeting with Dr. Avansino, we’ve seen such a difference in Bethany. She’s been doing so well!” said Church.

Bowel Management Week at Seattle Children’s, a one-week outpatient program to help children and teens control their bowels without having accidents or needing to wear a diaper, was incredibly beneficial for Bethany. After attending, she stays continent for weeks, without any accidents.

“We want people to know that there is hope and that they are not alone,” said Church. “We couldn’t be happier that we found Seattle Children’s, a place where we feel supported and involved. That’s why we wanted to share our story. It’s been such a long road for us. Now, we want to help others.”


If you would like to contact Seattle Children’s Reconstructive Pelvic Medicine Clinic, please email: [email protected]. To arrange an interview with Dr. Avansino or Dr. Ambartsumyan, please contact [email protected].