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Written by Mary White, Specialist Continence Adviser
Spina Bifida is an antenatally detectable congenital defect in the spinal cord in which one or more vertebrae fail to form. This fault can occur anywhere on the spine and the lesion can be open or closed, visible or invisible. The three main types are: Spina bifida Occulta, Cranium bifida and Spina bifida cystica.
Spina Bifida Occulta
This is the mildest and most common type. It can appear as a dimple or small hair growth in the back. If missed antenatally or immediately after birth, it can be detected later by x-ray. There may be no symptoms but bladder and bowel function may be affected in some cases.
Cranium Bifida
In this form the bones of the skill fail to develop properly.
Spina Bifida Cystica
Spina bifida Cystica (meningocele or myelomengocele) is a clearly visible cyst or blister on the back. It causes damage to the spinal cord which may lead to paralysis and loss of sensation below the level of the lesion.
Possible Effects of Spina Bifida
Possible effects of Spina Bifida cystica may include impaired mobility, scoliosis (back deformity) and double incontinence of bowel and bladder.
If there is no sensation of a full bowel and bladder, it is necessary to have a daily programme to ensure regular and complete emptying of both bowel and bladder. A full bowel presses upon the bladder, which is then unable to fill properly or empty completely. If the bladder does not empty completely and regularly, urinary tract infection (UTI) results. This can only be treated by antibiotic therapy.
Continence Management
Continence care is usually provided by a specialist centre. A good bowel management programme is essential if regular and complete bladder management is to be achieved.
The first line treatment for children whose bladders are affected by spina bifida is intermittent catheterisation (IC). The objective is to keep the child free of infection, thus protecting the kidneys and enabling them to enjoy the benefits of being dry by not having to wear nappy pads. The frequency of catheterisation depends upon bladder capacity but it is usually four or five times a day.
Over time the child will learn to carry out intermittent self catheterisation (ISC). Support is available if required, including a guide to Intermittent Catheterisation in Schools, available on request from Astra Tech.
Transition through mainstream education, further education and on into adult life is made much easier if continence management, ideally ISC, is effective.
There are many adults with spina bifida who for a number of reasons have never learned how to self catheterise and who may well be suitable. Other bladder management options include catheter drainage systems or pads but none offer the same lifestyle benefits as intermittent self catheterisation. For some people bladder reconstructive surgery may be necessary in order to render the bladder suitable for intermittent catheterisation while others are able to undertake the task without surgical intervention.
The Association for Spina Bifida and Hydrocephalus (ASBAH) is the UK’s leading organisation for all issues concerning spina bifida and hydrocephalus. See the links and useful contacts page in the Spina Bifida section for further details.
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