Bowel and bladder management of the child with myelomeningocele in the school setting

Parent and child experiences using a hydrophilic or reused PVC catheter for intermittent catheterisation

AIMS AND OBJECTIVES

To highlight the challenges faced in adjusting to intermittent catheterisation for families and children affected by spina bifida.

BACKGROUND

Toileting is a particular issue for children with spina bifida resulting in difficulty emptying their bladder. Management of incomplete emptying is intermittent catheterisation, which is now part of routine clinical care. The physical benefits of intermittent catheterisation are critical to renal health, and significant attention has been paid to this; less attention has been given to the personal aspects for the family or older child.

DESIGN

A descriptive study of satisfaction with two products for intermittent catheterisation: polyvinyl chloride and hydrophilic catheters based on data obtained from a randomised controlled trial on urinary tract infections in catheter users.

METHODS

At the end of each of the polyvinyl chloride and hydrophilic study arms, parents or older children completed a 'Satisfaction Questionnaire' and then participated in a follow-up interview. Data were analysed for emerging themes.

CONCLUSIONS

Three themes emerged: adjustment, ease of use and self-reliance. Key findings include: increased independence and confidence of the child catheterising using the hydrophilic catheter, self-management strategies to successfully manipulate the slippery hydrophilic catheter and reasons for the lack of success, and identification of participants who preferred polyvinyl chloride catheters. Descriptive data revealed potential areas where a hydrophilic catheter could improve the lives of the family and child as well as noting the need for user choice in product selection.

RELEVANCE TO CLINICAL PRACTICE

Listening to the stories of children and families increases the nurse's ability to act as a guide as families struggle to assist their children in reaching their potential. Incontinence has been demonstrated to be the cause of self-isolation potentially leading to a decreased sense of self-worth. Ambulatory care nurses play a large role in helping families find the routine and resources necessary to reduce the incidence of incontinence, in children with spina bifida.

Management of bowel dysfunction in children with spinal cord disease or injury by means of the enema continence catheter

Because bowel dysfunction in children with spinal cord impairment is a common and disabling problem that does not have adequate treatment, we evaluated the enema continence catheter developed in Toronto, Canada. Thirty-one children and their families were taught to administer a 20 ml/kg saline enema through this device. The children's bowel functions were evaluated 18 and 20 months after the start of the program. Six of the children dropped out of the study in the first 2 weeks and nine dropped out after between 18 and 30 months. For those remaining in the study, the proportion of continent stools rose from 28% to 94% (p less than 0.01); constipated stools dropped from 55% to 15% (p less than 0.01). Satisfaction with the bowel program increased, and five children were able to switch from diapers to lined underwear. No adverse effects were reported, and the amount of time required for toileting did not increase. Although compliance with the regimen was difficult for some families and its use carries potential risks, we believe that it can provide significant improvement in the bowel care of selected persons with spinal cord impairment.