Related Experiment Videos
Bowel and bladder control of children with myelomeningocele: a Nordic study
H R Lie1, J Lagergren, F Rasmussen
1Department of Pediatrics, University Hospital, Lund, Sweden.
Insights
Urinary and bowel control in children with myelomeningocele is challenging. Clean intermittent catheterisation (CIC) improves continence but increases antibiotic use, highlighting management complexities.
Area of Science:
- Pediatric Urology
- Neuroscience
- Rehabilitation Medicine
Background:
- Myelomeningocele frequently causes neurogenic bladder and bowel dysfunction.
- Urinary and bowel control significantly impacts quality of life in affected children.
Purpose of the Study:
- To evaluate urinary and bowel control in children with myelomeningocele.
- To assess the effectiveness and challenges of different management strategies.
- To define social urinary continence.
Main Methods:
- Retrospective review of medical records for 527 children (4-18 years).
- Parental questionnaires assessing continence and stress.
- Analysis of bladder management techniques including clean intermittent catheterisation (CIC) and manual expression.
Main Results:
- 433/527 children had neuropathic bladders; 31% used manual expression, 40% used CIC.
- CIC use correlated with better continence and less assistance but higher antibiotic rates.
- 412/527 children had disturbed bowel control; 212 used manual evacuation, often needing assistance.
- Urinary and faecal incontinence were reported as highly stressful by parents.
Conclusions:
- Social urinary continence is proposed as maintaining dryness for ≥3 hours.
- Effective bladder and bowel management is crucial for improving quality of life in children with myelomeningocele.
- Optimizing CIC protocols may reduce antibiotic-associated complications.
Abstract:
The urinary and bowel control was studied of 527 children with myelomeningocele aged between four and 18 years. Information was obtained from medical records and by parent questionnaire. 44 had normal urinary control, 50 had a urinary diversion and the remaining 433 had neuropathic bladder without urinary diversion, of whom 31 per cent expressed their bladder manually and 40 per cent used clean intermittent catheterisation (CIC). 60 per cent needed assistance emptying their bladder. Children using CIC were more continent and needed less help, but were more often treated with antibiotics. Of the 527 children, 412 had disturbed bowel control. 212 evacuated their bowels manually, of whom 90 per cent needed assistance. Parents judged urinary incontinence to be very stressful for 37 per cent of the children and faecal incontinence for 33 per cent. The authors conclude that social urinary continence should be defined as the ability to keep dry for three hours or more.