Abstract
Lower urinary tract dysfunction in children is a common multifactorial functional problem that often correlates with bowel dysfunction and behavioral disorders. Ideal management combines integrative therapies that optimize bladder and bowel habits, address behavioral issues, foster mind–body connection, and improve pelvic floor muscle dysfunction. Movement therapies that teach diaphragmatic breathing and relaxation, mind–body awareness, and healthy pelvic floor muscle function are vital for long-term symptom improvement in children. This paper outlines recommendations for integrative management of these patients and discusses a recently developed interprofessional clinic that aims to better meet these patients’ complex needs and to provide patients with an integrated holistic plan of care. Additional work is needed to scientifically assess these treatment models and educate providers across the various disciplines that evaluate and treat these patients.
Highlights
The National Institutes of Health National Center for Complementary and Integrative Health describes integrative medicine as the practice of bringing together conventional and complementary, or non-mainstream, interventions to provide well-coordinated and holistic care of a whole person [1]. This approach towards health care is beneficial to a wide variety of patients, including children with lower urinary tract dysfunction (LUTD)
The International Children’s Continence Society (ICCS) defines LUTD as the presence of irritative voiding symptoms in a patient age five or older over a given period of time specific to the symptom
We find that pelvic floor dysfunction in children often correlates with a variety of factors including painful voiding and stooling, anxiety and life stressors, and history of sexual abuse or other trauma
Summary
The National Institutes of Health National Center for Complementary and Integrative Health describes integrative medicine as the practice of bringing together conventional and complementary, or non-mainstream, interventions to provide well-coordinated and holistic care of a whole person [1] This approach towards health care is beneficial to a wide variety of patients, including children with lower urinary tract dysfunction (LUTD). Patients may need supplemental medical therapy to address persistent symptoms or treat infections, but it has been shown that medical therapy will rarely change the underlying cause of LUTD without the use of behavioral interventions and alternative therapies. We have recently designed and implemented an interprofessional clinic that allows for a more comprehensive evaluation of a patient’s LUTD that includes ruling out any underlying medical pathology, assessing the functional aspects of LUTD and BBD, and addressing associated behavioral, mind–body, and movement based needs
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