“Given the improved longevity of individuals with SB [spina bifida], transitional care issues (such as health-related independence) are becoming progressively more vital.”
Castillo et al. J Pediatr Rehabil Med. 2017;10(3-4):219-226.
Constipation and fecal incontinence are two symptoms of bowel dysfunction. There may be a cause, like impaired innervation of the intestine due to disease or injury. There may also be no traceable cause of the bowel symptoms; this is then called functional constipation or functional fecal incontinence.
The Cochrane review from 2013 by Jepson et al. 2013 was unable to recommend cranberry juice to prevent urinary tract infection (UTI). They furthermore identified a lack of evidence for the efficacy of other cranberry preparations (such as powders). New studies are, however, continuously added to the total weight of clinical evidence and the latest examples suggest that there may be benefits in this traditional remedy.Read More
The term spinal cord injury (SCI) comprises a wide range of conditions. As described by the WHO report International Perspectives on Spinal Cord Injury (WHO 2013), SCI refers to damage to the spinal cord arising from trauma (such as a car crash), or from non-traumatic disease or degeneration (such as tuberculosis), and encompasses both a baby born with spina bifida and a construction worker who falls from scaffolding.Read More
Urinary tract anomalies are sometimes seen in children, and many of them require active treatment to achieve continence. Vesicoureteral reflux and/or a neurogenic bladder secondary to meningomyelocele (e.g. spina bifida) are two examples that require swift action.
Catheterization is sometimes a suitable solution and new research has studied the need for local anesthetic associated with catheterization. A meta-analysis combined many study results and concluded that the effect of local anesthetic was limited.
Sometimes, catheterization is not possible through the urethra and a continent catheterizable channel is surgically created. Different procedures (e.g. Mitrofanoff) can be used and two new studies look into the complications associated with this kind of surgery. Both studies conclude that surgical procedures should only be used in children who cannot perform urethral catheterization, because surgical revisions and long-term complications are common.
Another, maybe more far-fetched, solution to these children's problems is the use of stem cell therapy. A new review summarizes the available evidence for stem cell therapy and show that the use of bone marrow stem cells has potential in bladder tissue regeneration.Read More
At the International Continence Society (ICS) meeting in Florence in 2017, there was a round table session dedicated to anal (or fecal) incontinence.
Right from the start in the opening statement, it was established that breaking the silence surrounding fecal incontinence is the most important first step. This is also the main conclusion of a recently published review, which covers clinical management of fecal incontinence from the gynecologist’s perspective: Medical professionals should always ask the patient about anal and fecal incontinence.Read More
Urinary tract infections (UTIs) are a heavy burden on the healthcare system today. UTIs are also one of the most common complications among people living with a neurogenic bladder, causing significant complications and health hazards. New clinical research investigates the clinical problem and demonstrates that UTIs are still among the leading causes of death in people with a neurogenic bladder.
On average, people with a neurogenic bladder experience 2 UTI events every year, requiring repeated antibiotic treatments. Frequent use of antibiotics is one of the main contributors to the high prevalence of antibiotic-resistant bacteria today, and as a result, UTIs are getting more expensive and more difficult to treat. As a consequence, there is a major focus in clinical research on the search for non-antibiotic prophylactic treatment for UTIs.Read More
There are many conservative options and combinations of methods when it comes to bowel management for people with neurogenic bowel disorder (NBD).
Usually they involve diet, exercise, laxatives, as well as other methods. For some people who have struggled with conservative bowel management, surgery has been the only alternative, but surgery is generally best avoided as there may be a number of complications associated with it.Read More
At a first glance, assisted urine voiding through catheterization may seem like an unnatural thing. If, however, the evidence surrounding intermittent catheterization (a more technical name for it) is studied, it becomes clear that this is indeed something useful. New research reveals that intermittent catheterization is a central part of many treatment regimens. In this month’s Science Alert we look into some of them.
Three newly published studies highlight the use of intermittent catheterization in children. The therapy is identified as a central treatment option for urological management of children with spina bifida, but it is also recognized as a suitable and central option in resource-poor settings. In another, more resource-strong setting, evidence in favor of hydrophilic-coated catheters for intermittent use has been found. The evidence suggests that hydrophilic-coated catheters decrease the risk of urinary tract infection (UTI), as compared to non-coated catheters, when used for intermittent catheterization in children with neurogenic bladder.Read More
New success stories are being published every month on how to reduce the burden of catheter-associated urinary tract infections (CAUTI).
The vast majority of studies share successful results from prevention programs and show a significant CAUTI reduction of 9% per year or even higher depending on the method used. The most important part of the solution is to restrict the use of indwelling catheters.Read More
Bowel function in children is a common concern, not only for the child but also parents and caregivers. As it is perceived as a measurement of health, deviations from normal bowel function often instigate numerous visits to a primary care provider.
Consequently, bowel dysfunction is one of the most common problems evaluated by pediatricians, pediatric gastroenterologists, and pediatric surgeons. This may be the reason why two recent publications review diagnosis, standard bowel care, and prevention of pediatric constipation.Read More
Initial management after spinal cord injury is crucial in saving lives. It is often characterized by early transfer to specialized centers and early initiation of treatments.
Long-term management is, however, almost as important. New research focuses on both of these and stresses the importance of early prevention of chronic complications, as these are common health problems affecting the quality of live for people living with a spinal cord injuryRead More
The battle against urinary tract infections (UTIs) is on. UTIs are a heavy burden for many: the healthcare system, society and, not least, the individual.
Recurrent problems are common among people with spinal cord injury and patients suffering from incomplete bladder emptying. The link between catheter use and UTI is also sufficiently strong to be defined by its own term, catheter-associated urinary tract infection (CAUTI).Read More
Chronic constipation (CC) is a common bowel dysfunction. There are several reasons for bowel dysfunction and several treatment methods, which are addressed in a new review article.Read More
Intermittent catheterization seems to be key to improving quality of life when living with a spinal cord injury. New research has confirmed that the therapy can increase the number of quality-adjusted life years (QALYs) by 93% and at the same time reduce urinary incontinence by 38%.Read More
Fecal incontinence (FI) is a debilitating condition with a significant health burden. Although it has great clinical relevance and a profound impact on quality of life, there is still not much known about how to effectively treat this condition. This may be due to the diversity of causes of fecal incontinence, but may also be due to the lack of clinical investigation into possible treatment therapies.Read More
Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and it has major cost implications for health services. It is a highly researched field with several new studies published every month covering prevention strategies and interventions.Read More
Catheterization is a therapy form with a long history, and its use for instant relief of urinary retention is not disputed. The classic case of urinary retention is often seen among men with an enlarged prostate. Less known is the prevalence of urinary retention among women.Read More
Available treatment options for bowel dysfunction vary depending on symptoms, but generally when starting therapy, a conservative approach is recommended. However, as one study shows, there is a reduction in bowel function over time in persons with neurogenic bowel disorders.Read More
The bladder and bowel share the pelvic floor and, in spite of known (and unknown) synergies, limited research has been undertaken on this topic. There are, for example, few studies exploring the impact of bladder and bowel dysfunction on social activities and quality of life.Read More