As the spina bifida population ages, there will be many people who have never had their continence issues addressed. This leaflet is intended to help this group to look at their bowel and bladder management.
shinecharity.org.uk email@example.com 42 Park Road Peterborough PE1 2UQ 01733 555988Continence Issues For Adults WithSpina BifidaAs the spina bifida population ages, there will be many peoplewho have never had their continence issues addressed. Thisleaflet is intended to help this group to look at their boweland bladder management.Bowel • Establish a bowel routine. Start a new regime on an empty bowel.Most people with spina bifida will Get your GP to check for high uphave bowel problems. These may blockages. You may need to haveinclude constipation, diarrhoea, and a good “clear-out” before you startfaecal overflow or be a combination a new way of doing things. Regularof all three. You need to know what emptying of the bowels shouldyour faeces should look like – you be encouraged. The best time isneed to aim for it to be firm but not after breakfast or other meal timeshard, well formed but not knobbly. when natural bowel movement is most active.If you have never been givenappropriate advice about bowel • Eat a well-balanced healthy dietmanagement you will probably with plenty of fluid and fibre to helpbe wearing pads with all the keep your motions soft and easyaccompanying difficulties (leakage, to pass. If you are unsure whatodour control, sore skin etc). constitutes a “healthy diet” speak to a dietician.You may like to try a different wayof dealing with your bowels: • It is important to exercise daily to the best of your ability as it helps to
Continence Issues For Adults WithSpina Bifidakeep your bowels moving. If you are • If you cannot manage to regulateunsure what exercises you are able your bowels, and still have episodesto do, ask your physiotherapist, or of soiling, enemas may be the nexttalk to someone at your local gym. step. Again, there are various types of enemas available depending on• Sometimes you will need to use your needs.a combination of diet and regularmedication - do not worry about • Some people use a system toyour bowel becoming “lazy”. If you completely clear the bowels outneed to take medicine then you every 2-3 days. This is called a highneed to take it. The medication bowel washout. A tube is insertedprescribed will depend on what your into your bottom (anus) and fluidbowel problem is. Medicines are is washed around the bowel. Theused to soften your stool, to help tube is removed and the fluid andyour motions pass easily, to clear any faecal matter will exit the bowel.the bowel out, to stop diarrhoeaand to make your stools more bulky. • When all these methods have been tried without success,• You may have always used surgery may be the only option.manual evacuation (using your Discuss this with your GP and askfingers to remove faeces from the him to refer you to a specialist. (Seelower bowel): although this is not Shine’s leaflets ‘ ACE Procedure’a method that is widely taught, if it and ‘Colostomy’)works for you there is no reason tochange. Keeping yourself constipated may seem like an easy option, but used• Gently stroking your anus over a long period can result in(bottom opening) with your finger complications, including a conditioncan sometimes produce a bowel called mega colon. It can alsomovement. cause faecal overflow; you need to be aware of the difference between• Coughing or blowing your nose diarrhoea and faecal overflow –or laughing whilst sitting on the many people think that they havetoilet may also produce a bowel diarrhoea when in fact it is overflow.movement. If this leads to incorrect treatment
ie giving anti diarrhoea medication, • Referral to a urologist with anyour bowel management will interest in the neuropathic bladderworsen. Also be aware that faecal (a bladder whose nerve supply mayoverflow can be misdiagnosed as be interrupted eg as in spina bifida).Irritable Bowel Syndrome and willneed investigating. • Access to a continence adviser with knowledge of the neuropathicIt is never too late to change! bladder.Bladder • An explanation of how good bladder management will protectYou may not be able to achieve your kidneys.bladder continence until you haveachieved bowel continence. • Regular (preferably yearly) urodynamics to check bladderHopefully you may have been seen and kidney function (see Shine’sby a urologist at some point in your leaflet “Tests and Procedures Usedlife and will therefore understand To Check Function of the Urinarythe importance of achieving System”).urinary continence. The prioritywhen managing your bladder is to • Ability to recognise urinary tractpreserve kidney function. If regular infections and know how to dealassessments are not carried out, with them.irreversible kidney damage mayresult. A bladder which does not There are several ways of managingwork normally might: urinary incontinence. Adults do not need to be sitting in wet pads.• cause urine to flow back to thekidneys; Talk to your urologist about:• not empty completely. This could • CIC or ISC (Clean Intermittentlead to urinary tract infections. Catheterisation or Intermittent Self Catheterisation – see Shine’sGood bladder management should leaflet on catheterisation).include:
• Medication to “calm” the bladder Remember to drink at least one cup(where appropriate). of fluid each hour during the day. Avoid “brown” drinks (tea, coffee,• Urinary sheaths (for men only) – a cola etc), anything with caffeine,device similar to a condom with a fizzy drinks. Clear fluids are besthole in the end which is attached to – there is nothing wrong with tapa bag. water!• Long term catheters into your To help avoid urinary tract infectionsbladder via the urethra (tube that drink a glass of cranberry juice eachurine comes out of) or through a day, 2 glasses a day if you have asmall incision in the abdomen (belly) current urinary infection. Cranberrycalled a supra-pubic catheter. Both tablets and capsules are available,types of catheter will need frequent but are less effective than the juice.changing either by the district nurse NB Do not drink cranberry juice oror at the hospital. take tablets/ capsules if you are taking a blood thinning drug such• Various surgical options, some of as warfarin or aspirin.which are not suitable for everyone.Ask your GP to refer you to a urologist Taking control of bladder and bowelto discuss your options. (It may be continence is a big step towardshelpful for you to read Shine’s leaflets achieving the independence thaton Mitrofanoff and Urostomy). you hope for, expect and deserve.Help usShine relies on people’s generosity and support so we can help our clientswho depend on us for help and advice - people with hydrocephalus, spinabifida, their families and carers. To donate to Shine please visitwww.shinecharity.org.uk or call 01733 421329.This information has been produced by Shine’s medical advisers andapproved by Shine’s Medical Advisory Committee of senior medicalprofessionals.Shine - Registered charity no.249338To see our full range of information sheets and to find out how to donate toShine please visit www.shinecharity.org.uk