Bladder and Bowel Management

for children with complex health needs and

life-limiting conditions

Slides written by June Rogers MBE- Director of PromoCon Editor: Dr Penny Dobson MBE 2011

What this presentation will cover

• How continence is achieved

• Why things may go wrong

• Management options

• Sources of further information and support

Anatomy of gastric and urinary tract

Sequence of events for achieving continence

• Control of the bowel when asleep

• Control of the bowel when awake

• Control of the bladder when awake

• Control of the bladder when asleep

Achieving continence is the interaction of two processes

Physiological maturation - ability to sit/walk/dress

- maturation of bladder / bowel Understanding and social awareness - understands/responds to instructions

- self esteem/motivation

- desire to imitate/identify with peers

- self determination and independence

6ICCS slide library v1 2010

Spinal pathways involved in micturition

What skills do children need

for toilet training?

• The ability to sit on a potty

• A bladder that will hold onto wee for at least an hour or more

• A bowel that is not constipated

• Some awareness of being wet/soiled

• Some awareness of what toilet training is all about

What continence issues may children have?

1. Children who have life limiting problems from infancy may well have associated delayed toilet training, as well as other bladder/bowel issues, so for some of these children the expectation may be that toilet training will never be a viable option

2 Children who have acquired problems – either through accident or illness (e.g. brain damage as a result of an accident or cancer) or have a degenerative disease such as muscular dystrophy – may have previously been toilet trained but may now have either lost that ability completely or have changing continence needs

 

What problems may children have?

Bladder problems:

• Wetting/incontinence

• Inability to empty the bladder

Bowel problems:

• Constipation

• Faecal incontinence