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Childhood Bladder and Bowel Issues

Childhood Bladder and Bowel Issues. Gill Yaz-Health Development Manager. Urinary Tract. Neuropathic Bladder. Detrusor over activity-high pressure, resists filling Areflexic bladder-low pressure, doesn’t empty Incompetent sphincter-doesn’t contain. Detrusor Sphincter Dyssynergia.

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Childhood Bladder and Bowel Issues

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  1. Childhood Bladder and Bowel Issues Gill Yaz-Health Development Manager

  2. Urinary Tract

  3. Neuropathic Bladder • Detrusor over activity-high pressure, resists filling • Areflexic bladder-low pressure, doesn’t empty • Incompetent sphincter-doesn’t contain

  4. Detrusor Sphincter Dyssynergia • Detrusor contracts against closed sphincter • High voiding and storage pressure • High risk for VUR , hydronephrosis • Thickening of bladder wall-low compliance • Resists filling • Incomplete emptying-risk of UTI • With VUR, very high risk of renal damage

  5. Children with spina bifida

  6. Medical Management • Clean Intermittent Catheterisation-CIC • Regular emptying • Relaxing detrusor with antimuscarinics-low pressure storage • Reduces storage pressure, allows filling, prevents thickening • Botulinum toxin injected into trigone

  7. The neurogenic bladder: medical treatment • Verpoorten & Buyse 2008 • ‘Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue.’

  8. Identification

  9. Urinary tract infection • Incomplete emptying ( residual) • Constipation • High pressure storage • CIC x 2 daily minimum • Treat if symptomatic • Discourage routine dip testing

  10. Social continence • Quality of life • Independence-cognitive, dexterity? • Surgery to improve storage, access? • Augmentation • Mitrofanoff/ Monti/ Button vesicostomy

  11. Augmentation

  12. Bowels

  13. Constipation • Diet-wean to vegetables, varied diet • Fluid intake • Encourage sitting on potty • Medication-macrogol, add stimulant if necessary • From 3yo, trans anal irrigation • ACE

  14. Trans anal irrigation

  15. Malone ACE

  16. Any Questions?

  17. Thank You

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