The nerves that allow a person to control when they urinate (pee) come from the lower part of the spinal cord. In children with myelomeningocele, these nerves usually don’t work. This creates two problems.
The first problem is possible damage to the kidneys. There are two things that can damage your child’s kidneys. These are pressure and infection. The kidneys make urine. Urine flows from the kidneys to the bladder through tubes called ureters. Most people empty their bladder five or six times a day. When your child is unable to completely empty the bladder, it overfills. Pressure backs up the ureter to the kidneys. This can cause pressure on the kidneys, which may damage them. Urine may also go back up the ureters, which is called urinary reflux. Reflux may allow bladder infections to reach the kidneys. Often there are problems with the bladder emptying out completely. Urine left in the bladder makes a good place for germs to grow and cause a urinary tract infection.
The second problem is that your child must be able to control when they urinate, so they no longer have to wear diapers or training pants, or worry about accidents. The goal is for your child to be able to control their bladder by school age. Wet pants cause odor, red and sore skin, urinary tract infections, and embarrassment.
Most children with a neurogenic bladder will need to start clean intermittent catheterization (CIC). You and your pediatric urologist (a doctor specializing in problems of the urinary tract in children) will decide when to start CIC. CIC involves emptying urine out of the bladder on a regular schedule using a small tube (catheter). CIC reduces the pressure in the bladder and kidneys. It drains urine to prevent infection and will help your child stay dry.
Many children will need a combination of CIC and medication to stay dry. The medications most often used to help children with neurogenic bladder are called anticholinergics. Ditropan® (oxybutynin chloride) and Detrol® (tolterodine) are examples of these medications. These medications help the bladder to relax so that it holds urine at low pressure. The medications come in liquid and tablet and capsule form. Anticholinergic medications may cause problems with heat intolerance, dry mouth and constipation. It is important that you talk with your pediatric urologist about these side effects if they occur.
Some children will require surgery to stay dry and to protect the kidneys from damage. This will be discussed with you based on your child’s test results. Pediatric urologists have good results treating children in a number of different ways.
It is important that a pediatric urologist see your child on a regular basis. Your child’s bladder and kidneys must be checked regularly so problems can be found early--before serious damage can occur.
Last Reviewed: April 2011