Continence Management
Most people with spina bifida have varying degrees of what is known as a neuropathic bladder and bowel - when damage to the nerves interferes with normal bladder and bowel working.
The priority when managing the neuropathic bladder is to preserve kidney function. If regular assessments are not carried out, irreversible kidney damage may result.
Infancy
Bladder
Early referral to a medical specialist for assessment of kidney and bladder function is essential. The specialist might be a pediatrician or a urologist.
A bladder which does not work normally might:
† cause urine to flow back to the kidneys;
† not empty completely. This could lead to urinary tract infections.
Many parents are now taught to do clean intermittent catheterisation as a precaution when their child is very young. This ensures regular bladder emptying.
Vesicostomy is sometimes preferred where the child is thought to be at particular risk of developing kidney damage. This is usually a temporary measure.
Bowel
Most babies with Spina Bifida have an abnormal nerve supply to their bowel which will alter "normal" bowel function.
The priority is to avoid constipation. In the early days, be aware of your child's bowel pattern. Aim to ensure regular soft stools which can be achieved by giving extra clear fluids, ie water.
When mixed feeding begins, encourage foods with a high fibre content, like cereals, prunes and other puréed fruits. It is important to continue to encourage the taking of extra clear fluids.
Pre School Children
These are the important years where the aim is to work towards continence.
Bladder
Renal tract investigations should be carried out at least once a year.
Remember the importance of fluids. At least 6 - 8 drinks per day should be encouraged to help reduce the risk of urinary tract infections. Ask about the choices for effective bladder management.
Cranberry juice is recognised as being useful in preventing and treating urinary tract infections, in some individuals. For these, one glass a day is recommended.
Bowels
Encourage a well balanced healthy diet. A high fibre diet will help to keep the motions soft and easier to pass.
Avoid eating too much food which can cause constipation, like eggs and full cream milk.
Introduce your child to the potty/toilet. Ensure that your child can sit safely and comfortably, supported or unsupported, with his/her feet placed on a firm surface.
Regular emptying of the bowels should be encouraged. The best time is after breakfast or other meal times when natural bowel movement is most active.
Maintain a high intake of clear fluids.
School Years
For the first time, working towards independent continence management becomes a prime objective. It is also a time when parents may have to involve others in the personal care of their child.
Bladder
As the bladder impairment may change, it is important to maintain monitoring of the renal tract by your paediatrician/urologist. This should take place at least once a year.
For many children, the need to catheterise during the school day is essential. Any special requirements to enable this to be carried out should be discussed with the appropriate professionals, and may need to be written into the
