Bladder management

The main goals of bladder management are to maintain good kidney function, prevent any kidney damage and achieve continence. 

'Continence' is the ability to voluntarily control emptying the bladder and bowels effectively in a socially acceptable place and hygienic way.

A healthy bladder stores urine and then empties the urine at appropriate times. People living with Spina Bifida can have what is known as a neurogenic bladder. This means that the brain and the bladder are not working together as well as they should. The two main problems that occur are:

  • the bladder does not empty properly (retention)
  • the bladder allows urine to leak either some or all the time (incontinence).

When urine cannot pass through the bladder

A bladder will not empty if the muscle that controls the opening (the sphincter) stays closed all the time. If it stays closed, the urine can鈥檛 pass through. If too much urine builds up in the bladder, it will cause a rise in pressure.

 This will then force the urine back via the ureters into the kidneys. Over time, this will cause pressure on the kidneys and, if it is not treated will damage the kidneys. 

Urinary tract infection (UTI) management

Urinary tract infections (UTI鈥檚) can also be a problem if the bladder is not emptied of urine. Repeated UTI鈥檚 can lead to kidney infections and kidney damage.

UTI's in Spina Bifida present differently as sensory issues mean that pain when passing urine is less likely to be present. Bacteria in urine does not necessarily mean that there is a UTI as catheterisation can also cause bacteria in urine.

Urinary Tract Infections (UTI's) in Spina Bifida can be caused by: 

  • Not emptying the bladder properly and urine stays behind for a long time. This allows bacteria to grow in the urine.
  • Unclean catheter techniques.
  • Chronic constipation causing difficulties with bladder drainage. 

The symptoms indicating a UTI in Spina Bifida are (in addition to the symptoms of a UTI without spina bifida):

  • Unusual wetting between CIC
  • Stinging when passing a catheter
  • Headache
  • Decreased appetite
  • Vomiting and a general feeling of being unwell. 

Cloudy, smelly urine and bacteria in urine are not enough to indicate a UTI in spina bifida as this can happen with catheters.

UTIs in Spina Bifida can usually be treated by:

  • Drinking more (dilution of the urine).
  • Performing an extra catheter (emptying the bladder more frequently).
  • Occasionally by using medications that prevent bacteria to stick to the bladder wall.

UTIs only need treatment with antibiotics when these strategies have not worked and the person living with Spina Bifida to become sick (symptomatic UTI).   

If antibiotics are given unnecessarily, a resistance against the more common antibiotics will develop. If an infection is multi-resistant, it can only be treated successfully with intravenous antibiotics.

Clean intermittent catheterisation (CIC)

The usual way to manage this type of bladder is with clean intermittent catheterisation (CIC). CIC is when a disposable catheter (plastic tube) is inserted into the bladder via the urethra to empty it. 

Once the catheter has drained as much urine from the bladder as possible, it is slowly removed. This is done during the day but not usually at night while your child is asleep. 

CIC is used to improve urinary control for people with abnormal bladder function. It helps prevent urinary infection and relieves pressure on the kidneys.

Drinking enough water is also important. Enough fluid will help prevent urinary tract infections and support good bladder health.

Bladders that leak urine

Bladders will leak urine if the muscle that controls emptying (sphincter) is relaxed most of the time. These types of bladders can still have risks of infection and kidney health will need to be monitored. 

It is important to keep your child clean and dry. Some medications can help improve urine storage in the bladder and reduce leakage.

You will be advised on their use by your treating doctor and nurse. Special attention needs to be given to your child鈥檚 skin to prevent rashes and skin injuries.