Magazine article The Exceptional Parent

Incontinence THE MEDICAL STORY

Magazine article The Exceptional Parent

Incontinence THE MEDICAL STORY

Article excerpt

Among the many challenges faced by people with disabilties, their parents, and families, the problem of urinary incontinence remains a high priority. This is because control of bodily functions is a personal and private concern involving the genitals and "private parts," and it affects feelings of self-confidence and self-worth.

Perspectives in incontinence

People with disabilties such as spina bifida, those with cerebral palsy, and some muscular dystrophies experience incontinence involving nerve and muscle control of the bladder and urinary channel. Disabilities also include those with abnormal formation of the bladder, such as bladder extrophy, where the abdominal wall fails to close, leaving the inside of the bladder exposed; or epispadias, where the urinary opening is on the top of the penis.

Treatment considerations for these individuals must be placed in perspective in terms of priorities. These priorities are:

1. Preserving kidney function

2. Avoiding urosepsis (life-threatening spread of urine infection to the bloodstream)

3. Achieving urinary continence

4. Maximizing independence

People with abnormal bladder function are at risk for problems that may shorten life due to infections, kidney failure, pressure sores from wetness, or high blood pressure from kidney damage. Most of these problems can be avoided. Children born with these problems now can benefit from lessons learned in the past.

Looking back

Prior to the 1950s, many people with incontinence were treated by leaving an indwelling catheter to drain the bladder into a bag. The constant contact of the catheter with the urine made infection, stones, and eventual erosion of the urine channel almost unavoidable.

In the 1950s, Dr. Bricker developed the ileal conduit, and through the 1960s and early 1970s this was thought to be the solution to the problem. The ileal conduit worked by bypassing the bladder and substituting an isolated segment of intestine to carry urine from the tubes draining each kidney to a stoma (an opening on the abdomen) and wearing a stoma appliance (an external bag to collect urine). This procedure avoided the need for an indwelling catheter.

Long-term complications, however, from the loss of kidney function to the undesirable aspects of having a stoma and a bag led to abandonment of this procedure.

The next procedure to be developed was urinary undiversion. This was accomplished by the means of a surgical procedure in which a segment of intestine could be added to the bladder to increase bladder capacity. A variety of techniques were developed to improve bladder control. The most significant of these was intermittent catheterization.

Intermittent catheterization--a safer way

Intermittent catheterization involves emptying the bladder periodically by using a clean, non-sterile technique that preserves both kidney and bladder function. Intermittent catheterization, performed whenever possible by the individual, and if not possible, by a caregiver, has achieved the goal of protecting kidneys, preventing infections, and allowing increased independence.

There is often significant resistance to the use of intermittent catheterization on the part of individuals and families. This is partly because it is not obvious that intermittent catheterization is safer than an indwelling catheter. It seems as if there would be an increased risk of injury and introduction of infection by the repeated passage of a catheter. There may also be significant psychological resistance, since most people grow up being told they should not think about their genitals, and by no means should they put anything in them. This resistance is usually overcome if the individuals give the technique a chance and recognize that it does, indeed, allow them to function and that it protects them.

The teaching of intermittent catheterization depends on patient, knowledgeable nursing personnel, and scheduling sufficient private time, free of interruptions or distractions. …

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