Influence of gait analysis on decision-marketing for lower extremity surgery

Bowel and bladder continence among children with spina bifida:a retrospective study

M CAMPBELL MS A, S DEMETRIDES CPNP A, E STASHINKO PHD A,
V ROGERS CPNP E, K SLIFFER PHD B, Y LAKSHMANAN MD D,
T A ZABEL PHD C, E LEVEY MD A

  1. 1. Neurodevelopmental Medicine;
  2. 2. Behavioural Psychology;
  3. 3. Neuropsychology, Kennedy Krieger Institute ;
  4. 4. Pediatric Urology, Johns Hopkins University;
  5. 5. School of Nursing, University of Maryland, MD, USA

Spina bifida (SB) remains a common birth defect in the USA, affecting approximately 1 in 3000 live births. Bowel and bladder continence has a significant impact on quality of life in individuals with SB.

Objectives: To describe (1) the ranage of continence outcomes for children with SB receiving usual care from an established multidisciplinary SB clinic; and (2) the physiological, medical, individual, family, and environmental factors that contribute to bowel and bladder continence in children with SB.

Study Design: A retrospective chart review.

Participants/Setting: Records of clinic patients evaluated during the past 3 years at a regional SB center were reviewed. Inclusion criteria included:age 5 to 18 years, SB diagnosis , and no history of bladder or cloacal extrophy or sacral agenesis/caudal regression. Sample mean age was 11 years 6 months; the majority (85%) had myelomeningocele. Fifty-one (53%) were males and 45 (47%) were females; 79% had hydrocephalus.

Methods: Medical records of 96 eligible patients, from a total of 116 screened, were abstracted.

Results: The majority of children (76/95) utilized clean intermittent catherization (CIC) for bladder emptying (of the 96 charts that were abstracted 95 had data that was able to be analyzed). Of the remaining children, nine were continent with spontaneous voiding, five used timed toileting, and five voided into a diaper. The vast majority of children using CIC reported some leaking (73%). Most children who had urine leakage also had bowel incontinence (74%). There was a positive relationship between having a recent urinary tract infection (UTI) and leaking between CIC/voids (Phi=0.41, p<0.01). Other treatments for urinary incontinence included anticholinergic medications (46%), urologic surgery (31%), and behavioral approaches. Bowel management included oral medications, suppositories, antegrade, and retrograde enemas, and assisted evacuation. Bowel surgery was done in 29%.

The top barriers to adherence to toileting routines for the child were initiation, anxiety, organization, and memory, and for adults/caregivers, lack of provision of positive reinforcement, lack of understanding of developmentally appropriate supervision, and lack of medication/routine organization.

Conclusions/Significance: The majority of children with SB still have some bowel and bladder incontinence despite medical intervention. This research demonstrated the prevalence of incontinence in this population and formed the basis for our current prospective randomized control study to assess whether a behavioral  intervention can improve compliance, decrease medical complications, and improve health-related quality of life in children with SB.

Acknowledgements: The support of the Association of University Centers on Disabilities (AUCD) and the National Center for Birth Defects and Developmental Disabilities (NCBDDD) RTOL 2005-5/6-01.

 
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