Bowel and urinary incontinence, which are stigmatizing and sometimes difficult-to-manage problems, are common in individuals and children with spina bifida. Surgeries to help with difficult-to-manage bowel incontinence have been available for almost 20 years.

Bowel Incontinence Treatment for Children with Spina Bifida
Surgery was introduced in 1990 that involved opening up the abdomen and placing a catheter into the intestine in order to administer an enema. It helped with bowel problems, but it was very invasive for children with spina bifida. 

In 1996, a more minimally invasive technique was introduced which involved an ostomy tube placed into the intestine laparoscopically (a surgical technique using three small incisions through which cameras and tools are threaded). The part of the intestine that is used is the cecum; therefore, the tube is called a cecostomy tube. A button covers the top of the tube when it is not used, so it is a very clean way to administer an enema.

Bowel and Bladder Incontinence Treatment
Surgeries are also available to help the same individuals manage their urinary incontinence if traditional intermittent catheterizations are difficult to perform. 

The appendix is often used to form a passageway from the bladder to the surface of the abdomen, making intermittent catheterizations possible. The procedure is called an appendicovesicostomy and the passageway is called a urinary conduit. 

When the appendix is long enough, two separate channels are created so it can stay connected to the intestine for an enema to be administered.  That way, both the bowel and bladder can be managed through one passageway.  However, not everyone's appendix is long enough for this to be possible.

This study describes a procedure in which placement of the cecostomy tube and the urinary conduit are done at the same time using a minimally invasive technique on three children with spina bifida aged 10-13.  All of them were prescreened to make sure they had stable bladders and were appropriate for the procedure. In addition, these children had intractable constipation and fecal soiling, despite aggressive bowel management routines. All demonstrated good hand coordination, but had difficulty with catheterizing per urethra because of their body habitus and/or challenging access while in the sitting position.

Quality of Life for Children with Spina Bifida
All three children had successful procedures.  Within three weeks of the procedure, the children were able to empty their bladders and administer an enema through two separate, very small, clean openings in their abdomen.  As a result, the children were able to achieve social continence without reliance on protective undergarments and with better control of their bodily functions.

Conclusions 
Not all children with spina bifida who have bowel and urinary incontinence need this type of procedure, but for those who have a short appendix and some other limiting factors, this procedure is an excellent option.

For more information: "Minimally Invasive Approach for Treatment of Urinary and Fecal Incontinence in Selected Patients with Spina Bifida," A. Lorenzo, P. Chait, M. Wallis, A. Raikhlin, W. Farhat, Urology, volume 70, issue 3, p. 569-571, September 2007.

See Related Articles
Symptoms of Spina Bifida differ with age.  For more information, see Spina Bifida Patients Encounter Different Problems as Young Adults.

Teens with Spina Bifida have an increased change of complications with their bones.  Learn more about this issue in Adolescents with Spina Bifida at Higher Risk for Bone Fractures.