170 chapter 22
Bladder and bowel management
A child with spina bifida usually does not develop the same control of peeing (bladder
control) and shitting (bowel control) as other children do. The child may always dribble
urine. Or, as she gets older, she may continue to empty her bladder or bowels without
warning, perhaps without even knowing or feeling it. Standard methods of toilet training
will not work. Do not blame or scold her for her accidents.
WARNING: In some children
with spina bifida, the bladder
does not empty completely. This
is dangerous because if urine
stays in the bladder for a long
time, bacteria will grow in it and
this can lead to infection of the
bladder and kidneys. In children
with spina bifida, urinary
infections are a frequent cause
of death.
bladder
too full
A mother can learn to feel
how full the bladder is, and
to tap on it gently to see if
this makes the baby pee. If
not, she can regularly press
gently on the bladder to push
out the urine.
Later, some children can
learn to empty their bladders
by crying, rolling over,
laughing, or sneezing. Others
learn to do it by pressing
on the stomach, like this,
although this can also be
risky (see p. 209).
Some children may
need to use a ‘catheter’
or rubber tube to get
the urine out. By age 5
they can often learn to
‘catheterize’ themselves.
(See p. 206.)
Girls often need to empty
the bladder regularly with
a catheter, and perhaps use
diapers (nappies) to catch
any urine that drips out in
between.
As they grow older,
boys are often able
to use a ‘condom’
connected to a bag
that collects the
urine. (See p. 207.)
For girls, a mirror helps in
finding the urine hole.
Most children with spina bifida can be helped to take care of both their bladder and
bowel so that they stay relatively dry, clean, and healthy. Then they can go to school
and do things outside the home with greater confidence. Therefore, it is extremely
important that rehabilitation workers and family members help the child work out a
good bladder and bowel program.
IMPORTANT INFORMATION on urinary and bowel problems
and prevention and treatment of urinary infections is in Chapter
25, p. 203 to 214. Be sure to study this chapter!
Disabled village Children