Bowel and Bladder Issues

*Excerpted from Understanding Spina Bifida

Bowel and bladder function is controlled by the sacral nerves at the bottom section of the spinal cord. Since most lesions are at or above the sacral level almost all children with spina bifida will have problems with bowel and bladder function.

Bowel Function

The amount of bowel muscle control and sensation in each individual varies greatly depending on the level of the lesion, as well as the amount of damage to the nerves. Also, due to decreased sensation, many people will not be able to feel the need to have a bowel movement. This can lead to:


Constipation

Fecal Incontinence
  • muscles of the bowel are weak resulting in waste material moving more slowly though the bowel; results in dry hard stools
  • anal sphincter muscles are weak which causes bowel accidents or leakage

It is important to establish a good continence routine early in life in order to avoid constipation or incontinence as much as possible.

Bladder Function

Messages between the bladder, sphincter muscles, spinal cord and brain are interrupted due to nerve damage at and below the site of the lesion. Bladder muscle control and sensation will be limited, but the limitations will vary greatly depending on the level of the lesion.

 

The following two types of bladder function problems may result:

Small Spastic Bladder

Large Flaccid Bladder
  • bladder is usually small and holds little urine
  • results from uncontrolled contractions of the bladder muscles
  • can lead to reflux, hydronephrosis, and abnormal wetness
  • bladder is usually large with a relaxed sphincter
  • results from inability of the bladder muscles to contract properly
  • may lead to frequent infections caused by poor emptying of the bladder and abnormal wetness

Preventing and/or Reducing Urinary Tract Infections

Regular emptying of the bladder through catheterization is important to reduce the length of time the urine is held in the bladder. Extra water intake as well as cranberry juice or capsules are also beneficial. For some individuals, antibiotics or bladder irrigation may be recommended.

Symptoms of a UTI

  • cloudy, smelly urine
  • abnormal wetting
  • blood-tinged urine
  • fever
  • irritability
  • mild back pain

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