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"The brain-bladder tango."

Updated: Mar 23

Navigating the intricate pathways of nerves and muscles in the world of pediatric urology.


Spina Bifida and Neurogenic Bladder


Spina bifida is a congenital condition that results from the incomplete closure of the embryonic neural tube. This defect, which occurs during the first month of pregnancy, leads to an array of complications, including neurogenic bladder.




This subchapterpost will delve into the interrelation between spina bifida and neurogenic bladder, elucidating the intricacies of these conditions in a simplified manner suitable for the scope of paediatric urology.


Children born with spina bifida often experience difficulties with bladder and bowel control due to the associated nerve damage. This is where the term 'neurogenic bladder' comes into play. Neurogenic bladder is a urinary condition in which impaired nerves prevent the bladder from emptying properly. This impairment can lead to urinary incontinence or urinary retention, both of which can have significant impacts on a child's quality of life.




Neurogenic bladder in spina bifida patients can manifest itself in two forms - flaccid or spastic.




A flaccid bladder, often seen in children with lower spinal lesions, is one that cannot contract properly. This leads to an overflow of urine, resulting in incontinence.



In contrast, a spastic bladder, typically associated with upper spinal lesions, contracts frequently and without control. This leads to a small bladder capacity and frequent, uncontrolled urination.






The management of neurogenic bladder in children with spina bifida is crucial in preventing complications, including urinary tract infections, kidney damage, and ultimately kidney failure. The primary goal of treatment is to achieve continence, protect the kidneys, and improve the child's overall quality of life. The approach to management is typically multi-disciplinary, involving urologists, neurologists, nephrologists, physiotherapists, and often psychologists.


The first line of management usually involves conservative measures such as timed voiding, where the child is encouraged to empty their bladder at regular intervals, and the use of absorbent products. However, in cases where these measures are insufficient, medications may be administered. These can help to relax the bladder muscle, reducing the frequency of uncontrolled contractions and thereby increasing bladder capacity.


In some cases, surgical intervention may be required. This can involve procedures to increase bladder capacity, reroute urine flow, or even create a new way for the child to empty their bladder. The choice of surgery is highly individualized, considering the child's specific condition, their age, and their personal and family preferences.


It is essential to remember that living with spina bifida and a neurogenic bladder can be challenging for a child and their family. Therefore, psychological support and counselling are important aspects of management. Educating the child and their family about the condition, its management, and potential complications is also crucial.


In conclusion, the interplay between spina bifida and neurogenic bladder presents unique challenges in paediatric urology. However, with a comprehensive, multi-disciplinary approach to management, many of these children can lead fulfilling lives.


Cerebral Palsy and Bladder Dysfunction


Cerebral palsy (CP) is a neurological disorder that affects a child's movement, motor skills, and muscle tone. It is caused by damage to the brain, usually occurring before, during, or shortly after birth. Among the various challenges that children with cerebral palsy face, bladder dysfunction is a common yet often overlooked issue. Understanding the relationship between cerebral palsy and bladder dysfunction is vital for providing comprehensive care to these children.


Bladder dysfunction in children with cerebral palsy can manifest in various forms, with the most common being neurogenic bladder. Neurogenic bladder refers to a lack of bladder control due to a brain, spinal cord, or nerve condition. In cerebral palsy, the brain's damage prevents it from sending the correct signals to the muscles controlling bladder function. Consequently, these children may experience problems with storing or emptying urine.


There are two types of neurogenic bladders associated with cerebral palsy – overactive and underactive. An overactive bladder contracts too frequently, leading to symptoms such as urgency, frequency, and incontinence. In contrast, an underactive bladder does not contract enough, causing difficulties in complete bladder emptying, leading to urinary retention and potentially, urinary tract infections (UTIs).




The impact of bladder dysfunction on a child's life can be significant, affecting their social interactions, self-esteem, and overall quality of life. Children may feel embarrassed about their lack of control, leading to social isolation. Additionally, recurrent UTIs can cause discomfort and disrupt their daily activities.


Bladder dysfunction in cerebral palsy is diagnosed through a combination of clinical evaluation, patient history, and specific tests. These tests may include a urinalysis to check for infection, a bladder scan to assess how well the bladder empties, and urodynamic studies to evaluate bladder and sphincter function.


Management of bladder dysfunction in children with cerebral palsy is multifaceted and should be tailored to the child's specific needs. Therapeutic strategies aim to improve bladder storage and emptying, prevent UTIs, and enhance the child's quality of life. These may include behavioral modifications, bladder training exercises, medications, and in some cases, surgery.


Behavioral interventions are often the first line of treatment and may involve scheduled toileting, dietary modifications, and fluid management. Bladder training exercises can help strengthen the muscles involved in urination and improve bladder control. Medications may be used to relax the bladder or reduce bladder contractions. In severe cases, surgery may be considered to increase bladder capacity, improve urinary flow, or manage incontinence.



Neurogenic Bowel


One other condition that demands our attention is the neurogenic bowel. This refers to a malfunctioning bowel due to damage to the nerves that control its function. This condition is often seen in children with spinal cord injuries or congenital conditions such as spina bifida. The inability to control bowel movements can lead to a variety of complications, including constipation, incontinence, and even damage to the rectum and colon.




The nerves that control bowel function originate in the spinal cord. When these nerves are damaged, the messages that signal the need for a bowel movement may not be effectively communicated, leading to a lack of control over bowel movements. This can manifest as either constipation, where the child is unable to pass stool, or incontinence, where the child is unable to withhold stool.


The symptoms and severity of neurogenic bowel can vary greatly from child to child, depending largely on the location and extent of the nerve damage. In general, children with lesions above the sacral level of the spinal cord tend to experience constipation and lack the ability to feel the urge to defecate. On the other hand, children with sacral or lower lesions often struggle with incontinence.


Management of neurogenic bowel involves a multidisciplinary approach. Paediatric urologists, gastroenterologists, dieticians, and physical therapists all play a role in creating a comprehensive treatment plan. This may include dietary changes, medication, bowel training programs, and in some cases, surgery.


Diet plays a crucial role in managing neurogenic bowel. A diet rich in fiber can help regulate bowel movements and prevent constipation. Children should also be encouraged to drink plenty of fluids, as dehydration can exacerbate constipation. Physical activity can also help stimulate bowel movements.


Medication may also be prescribed to manage symptoms. Stool softeners, laxatives, and enemas can all help manage constipation. On the other hand, antidiarrheal medications may be used to treat incontinence.


Bowel training programs involve establishing a regular schedule for bowel movements. This can help train the body to pass stool at specific times. These programs may also involve techniques to stimulate bowel movements, such as digital stimulation or the use of suppositories.


In severe cases, where conservative management is not successful, surgery may be considered. This may involve procedures to create a stoma, which is an opening in the abdomen that allows stool to be removed from the body. Alternatively, procedures to strengthen the anal sphincter or to stimulate the nerves controlling bowel function may be performed.


In conclusion, neurogenic bowel is a complex condition that requires a comprehensive and individualized approach to management. Through a combination of dietary changes, medication, bowel training, and potentially surgery, children with neurogenic bowel can achieve improved bowel function and a better quality of life. As with all medical conditions, early detection and intervention are key to managing neurogenic bowel effectively.



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