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Updated: Aug 26, 2026
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Published on: February 10, 2023
Neuropathic bladder and intermittent catheterization: social and psychological impact on children and adolescents
Melinda Edwards1, Malgorzata Borzyskowski, Antony Cox
1Guy's and St Thomas' Paediatric Trust, London, UK. melinda.edwards@gstt.sthames.nhs.uk
Insights
Children with neuropathic bladder using clean intermittent catheterization (CIC) and self-catheterization (SC) report no significant self-esteem impact. Key challenges include learning the technique and managing leakage, with peer discovery being a concern.
Area of Science:
- Pediatric Urology
- Psychosocial Health
- Rehabilitation Medicine
Background:
- Neuropathic bladder significantly impacts children and adolescents, necessitating bladder management strategies like catheterization.
- Clean intermittent catheterization (CIC) and self-catheterization (SC) are common interventions, but their psychosocial effects require thorough investigation.
- Understanding the lived experiences of young patients and their families is crucial for optimizing care and support.
Purpose of the Study:
- To explore the psychosocial impact of CIC and SC on children and adolescents with neuropathic bladder.
- To investigate children's understanding and practical experiences with catheterization techniques.
- To assess the effect of catheterization status on the emotional well-being and self-esteem of pediatric patients.
Main Methods:
- Semi-structured interviews with 28 children/adolescents (ages 5-20) with neuropathic bladder.
- Use of drawing self-portraits and figure diagrams to understand catheterization concepts.
- Administration of age-appropriate self-esteem measures.
- A postal questionnaire extension study involving 42 children/adolescents using SC.
Main Results:
- No significant differences in self-esteem were observed between children successfully using CIC/SC and controls.
- Key challenges identified include the learning curve for SC and practical issues like leakage and maintaining dryness.
- Concerns about peers discovering their continence management strategies were also reported.
Conclusions:
- While catheterization does not appear to negatively impact self-esteem, specific challenges require targeted support.
- Educational strategies and problem-solving support are vital for families and young people to maximize the benefits of catheterization.
- Addressing practical concerns and psychosocial aspects can enhance cooperation and overall outcomes for pediatric patients with neuropathic bladder.
Abstract:
This paper describes part of larger study involving 40 families of children and adolescents with neuropathic bladder looking at the psychosocial impact of catheterization on them and their families. This study focuses on their experiences of clean intermittent catheterization (CIC) and self-catheterization (SC). Twenty-eight children and adolescents (11 males, 17 females; mean age 9 years, SD 2 years 7 months, range 5 to 20 years) with neuropathic bladder (mostly with spina bifida) participated in a semi-structured interview to explore their understanding of micturition and catheterization, and their views about the introduction and practical use of this technique. Participants were invited to draw self-portraits and figure diagrams to depict their understanding of CIC and SC. Age-appropriate self-esteem measures (Harter Pictorial Scale of Perceived Competence, the Self-Perception Profile, and the Culture-Free Self-Esteem Inventory) were administered to see if catheterization status affected emotional well-being. In an extension of this study, children's experiences of SC were explored by a postal questionnaire to all children successfully using SC who were attending the Paediatric Neuropathic Bladder Clinic. Children aged <5 years, those with learning difficulties, and those using indwelling catheters were excluded. From a total sample of 66 (31 females, 35 males), 52 parents and 42 children and adolescents (28 females and 14 males) responded. No significant difference was observed in self-esteem for those successfully catheterizing. Specific challenges involved learning SC and practical use of the technique. Concerns were leakage and being wet, and peers finding out about their continence management. Implications for the education, problem solving, and support of families and young people to promote cooperation and optimal benefits from catheterization are discussed.
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