Bladder and Bowel Continence for Individuals with Spina Bifida

If you or someone you love is dealing with continence issues related to spina bifida, you are not alone! At Hydrocephalus Canada, we can connect you with information, support and others who are willing to share their ideas, experiences and lessons learned about bowel and bladder management. Knowledge is power. We understand that these are sensitive and difficult issues to discuss and they can greatly impact health, social and emotional well-being. We can help! 

Achieving bowel and bladder continence for individuals with spina bifida is a vital part of staying healthy and being independent. Not having control of your bowel and bladder can have a great impact on your life. Both need to be monitored by a health care provider and assessed throughout your life. It is a major goal that children, parents, adults and health care providers always hope to reach, however, getting there can be challenging.

Most individuals with spina bifida do not have intact nerve pathways in the spinal cord to signal a bowel movement or that their bladder is full and needs to be emptied.  This is referred to as a neurogenic bowel/bladder.

This section of the website will provide information to assist parents and adults to work with their health care professionals to manage bowel and bladder continence. 

BLADDER CONTINENCE    

Most individuals with spina bifida will have bladder function issues due to nerve damage which interrupts the messages between the bladder, sphincter muscles, spinal cord and the brain.  The amount of damage and bladder control varies depending on the location of the lesion.  A bladder management program is also based on individual needs and which methods work best. 

The priority and goal is to preserve kidney function as long as possible and manage urinary continence.  A bladder that does not work normally might not empty properly and urine may flow back into the kidneys leading to urinary tract infections (UTIs) and other life threatening issues. Our partner in bladder health, Coloplast Canada, has some great information on avoiding urinary tract infections: 

How to Avoid a Urinary Tract Infection
Comment Eviter Les Infections Urinaires

Regular visits to a urologist is paramount.  These visits could include various tests to monitor your bladder and kidneys such as a renal and bladder ultrasound, renal scan, intraveious pyelogram (IVP), voiding cystourethrogram, urodynamics, cystoscopy and urine tests.

The Neurogenic Bladder

drawing of bladder and kidneysPeople with spina bifida, particularly the myelomeningocele form, “have impaired autonomic [nerve] function and may therefore have absent or minimal sensation of bladder fullness and an inability to initiate the voluntary, coordinated process of urination.” (Sandler, Adrian (1997). Living With Spina Bifida, A Guide for Families and Professionals, University of North Carolina Press, p.25). Autonomic nerves are responsible for transmitting messages from organs to the brain. In this instance, the message that your bladder is full does not get properly sent to the brain. Also, the nerves that control voluntary muscles like the urinary sphincter and the relaxation and contraction of the bladder itself don’t work properly. This miscommunication between your brain and bladder can cause several problems including:

  • lack of control of urination
  • Incomplete emptying of the bladder
  • Increased pressure that can lead to complications such as urinary tract infections, reflux (urine forced back up towards your kidneys) and kidney damage.

Proper management can help avoid these problems that can lead to life-threatening issues! There are too many tragic stories to sit back and do nothing. Bladder infections and other problems are serious and need to be treated quickly.

How Does the Bladder Work?
Comment la vessie fonctionne-t-elle?
SB and Bladder Function

Urinary Continence Programs/Methods:

  • Clean Intermittent Catheterization (CIC)
  • Other types of catheters-condom catheter, indwelling foley catheter, suprapubic catheter
  • Medication
  • Crede technique (pushing on bladder with your fingertips)
  • Urinary diversions-ileal-conduit, continent stoma, vesicostomy, Mitrofanoff procedure
  • Surgical intervention-bladder augmentation, sphincter tightening
  • Biofeedback and electrical stimulation
  • Botox treatments

An effective bladder program will reduce common problems such as UTI’s, overfull bladder, bladder and kidney stones, reflux, hydronephrosis and bladder accidents. Even the food you eat and what you drink can make a difference in the health of your bladder. 

HEALTHY FOOD AND BLADDER ISSUES
ALIMENTATION SAINE ET TROUBLES URINAIRE

 

Our partners at COLOPLAST CANADA have compiled a list
of FREQUENTLY ASKED QUESTIONS about bladder problems.
QUESTIONS FRÉQUEMMENT POSÉES SUR LES TROUBLES DE LA VESSI

 

 

BOWEL CONTINENCE

Most people living with spina bifida will experience bowel issues related to having what’s called a neurogenic bowel (explained in detail below). Each person’s bowel program is based on individual needs and which methods work best for you. To manage bowel continence you may need to explore a variety of options before you find the right fit for you. A good bowel program aims to keep stool firm, empty the bowel at a specific time daily or every few days and not to have any bowel accidents.

The Neurogenic Bowel

frawing of impacted bowleMost individuals with spina bifida will have common bowel problems related to the damage to the nerves responsible for the sensation of bowel fullness and emptying. Constipation, impaction, diarrhea and bowel accidents are all possible. Signs of bowel problems can include hard stool, no stool, poor appetite, abdomen is enlarged and feels hard, blood in the stool or loose stool that leaks around the hard stool.

Exercise, drinking plenty of fluids and eating a healthy diet high in fiber can help in achieving a bowel program that works for you.

If a bowel management program is not effective, surgical treatments are available. 

HOW THE BOWEL WORKS (Coloplast Video)
VOUS-SOUFFREZ DE TROUBLES COLORECTAUX
UNDERSTANDING BOWEL FUNCTION

 

Bowel Management Programs/Methods:

  • Habit training
  • Digital stimulation
  • Disimpaction
  • Stool softeners and bulk formers
  • Suppositories
  • Laxatives
  • Enemas, fleets and enema continence catheters
  • Diet and exercise

Exercise, drinking plenty of fluids and eating a healthy diet high in fiber can help in achieving a bowel program that works for you. 

WHY IS BOWEL CARE SO IMPORTANT?

If a bowel management program is not effective, surgical treatments may be needed.  These may include the MACE (Malone Antegrade Continence Enema), cecostomy/c-button procedure or a colostomy. 

 

Our partners at COLOPLAST CANADA have compiled a list
of FREQUENTLY ASKED QUESTIONS about bowel problems.
VOUS SOUFFREZ DE TROUBLES COLORECTAUX 

 

We are happy to welcome COLOPLAST CANADA as our new partner
in providing information on bowel and bladder health.