Bowel and bladder control is an important part of any child’s learning and development, and a child with cerebral palsy is no different. CP children in particular often have difficulty with bowel and bladder control, since these functions require well developed muscle tone and coordination. Conquering these issues can be a monumental occasion for children with cerebral palsy.
Children with developmental disorders receive toilet training by age five, whereas most children can achieve continence before age three, according to a study conducted in 2006. The study went on to discuss how continence is unlikely to occur after a child with developmental disorders reaches age 8. Thankfully, there are a variety of products to help children with incontinence, including collection devices. In fact, some studies suggest that medication combined with a collection device can prove successful for older children with incontinence issues.
Different types of incontinence
Incontinence can be broken down into many different categories. Stress incontinence refers to incontinence brought on by physical activity, or by involuntary actions such as coughing or sneezing. Urge incontinence describes spontaneous urination that follows the urge to urinate. Fecal/bowel incontinence, as the name suggests, occurs to involuntary or otherwise uncontrolled release of stool. Overflow incontinence is the inability to completely empty the bladder. In addition, some adults and children are affected by multiple forms of incontinence. This is known as mixed incontinence.
Bladder incontinence, also called neurogenic bladder, refers to a condition that causes uncontrollable urination. Urine control is the function of both the bladder and the sphincter muscles. The sphincter surrounds the bladder and contracts in order to prevent urine from leaking out. In turn, the bladder’s wall muscles need to be able to relax to allow the bladder to expand. For some children with cerebral palsy, these muscle groups are weakened, which can lead to bladder incontinence.
Some children may also suffer from constipation, especially children with cerebral palsy. If stool blocks the rectal passageway, the muscle walls surrounding the anus and sphincter can become damaged or weakened. When dealing with constipation, it is best to take your child to a specialist, such as a proctologist or gastroenterologist, who can perform a full medical evaluation of your child’s digestive and bowel systems. Physical therapy programs or special devices can further assist your child with his or her bowel movements, if necessary.
How to test for incontinence
A trip to your child’s doctor should help address any concerns you may have about incontinence. Preferably, you should visit a doctor who specializes in issues related to the bladder, who are known as urologists. They can give your child a full evaluation based on their daily diet, activities and stress factors they may encounter. Urologists can also perform urine tests, an EMG, uroflowmetry or cystometry to determine if your child has any incontinence issues.
Incontinence treatment options
There are a variety of treatment options and therapies for CP children with incontinence. The most basic form of treatment is maintaining proper toilet posture. Special devices, such as potty chairs, can be helpful in getting a child accustomed to the proper way to sit on a toilet. In other cases, muscle re-education therapists can teach a child comfortable hip abduction and foot/buttocks support. If the child is relaxed while sitting, the pelvic floor muscles and abdominal muscles should be prevented from activating. Other treatments include medications, surgical implants, exercises and biofeedback.
Another option is urotherapy, which is a bladder rehabilitation program. Usually, the therapy involves muscle re-education, regularly scheduled hydration, pelvic floor muscle exercise and other techniques, barring medication and surgery. It is a good idea to sit down with your child and the therapist who will be working with them to discuss such topics as fluid intake, hygiene issues (such as soiled clothing), bowel dysfunctions, and anger management before outlining and beginning the therapy program.
A third option is drug therapy. There are a variety of medicines available that are designed to target the pelvic floor and abdominal muscles. However, all of these medicines are known to have side effects and some may not be approved for use in children. The International Children’s Continence Society recommends the use of 69 medicines only after other treatment options have failed to show positive results.
Finally, you may opt to have your child undergo surgery in order to correct his or her incontinence. Many different surgery options are available, including a procedure known as neuromodulation, which has shown specific potential for helping children with cerebral palsy combat incontinence.
Techniques for Toilet Training
In Southern California, The Diagnostic Center has been performing tests on a recent training technique, which they call “habit training.” The process involves training your child’s mind to void based on a visual cue, signal or sound effect. For more information on this technique, you can read a six-page hand-out that The Center has put together on their website.
Other methods include having your child use a wristwatch programmed to go off at particular moments during the day, which can help them with managing bowel control. A study published in 2010 indicated that scheduled trips to the restroom throughout the day can significant help a child with cerebral palsy with incontinence.