Incontinence (difficulties controlling bowel and bladder movements) in children with cerebral palsy is very common.
Most individuals with cerebral palsy eventually learn to avoid bowel and bladder-related accidents, but at a slower rate than the general population.
This article will explain why people with cerebral palsy may take longer to achieve continence and how to manage incontinence.
Let’s get started!
Cerebral Palsy and Incontinence
One of the defining characteristics of cerebral palsy is abnormal muscle tone.
Spasticity is when your muscles involuntary contract, resulting in prolonged periods of high muscle tone.
When the muscles in your bowel or bladder don’t contract, you retain waste, which can cause urinary tract infections or constipation.
Additionally, when the detrusor (the muscle that makes up the wall of the bladder) contracts, the bladder can only hold a little bit of urine and leaking occurs.
Factors that Affects Incontinence in Cerebral Palsy
Other cerebral palsy-related factors that can cause incontinence include:
1. Severity of Motor Impairments
Generally, the more severe your motor impairments, the more likely one is to have urinary incontinence.
Those with higher Gross Motor Function Classification System (GMFCS) levels have less mobility and more extreme spasticity, which increases risk of incontinence.
2. Location of Motor Impairments
Cerebral palsy can affect various areas of the body.
It can affect just the legs, half the body, your entire body, or only 1 limb.
For example, if your child has normal arm movements, they can get to a bathroom, perform their own transfers, and undress themselves.
A child without normal arm functions may not be able to independently use the bathroom. If someone is not constantly with them, they are more prone to bowel and bladder-related accidents.
Individuals with spastic hemiplegia (when CP only affects one side of their body) are less likely to experience incontinence. It’s believed that neuroplasticity (the central nervous system’s ability to adapt) can influence the “unaffected side to assume more control over the bladder during development.”
3. Intellectual Disability
Although CP and intellectual disabilities are not directly related, nearly 50% of all individuals with CP have an intellectual disability.
If a child with cerebral palsy has an intellectual disability, they may not be conscious of their bladder filling or what to do when they need to use the bathroom.
4. Communication Skills
Cerebral palsy can affect the muscles around the mouth, making it difficult for individuals to communicate their needs.
Generally, as long as an individual can express when they need to use the toilet and someone is there to help them, accidents can be avoided.
Because many children with cerebral palsy lack control over their muscles, it may take them longer to develop bladder and bowel management skills.
This study involved 459 individuals with cerebral palsy between the ages of 4-18 and found that 70% of the participants learned how to control their bowel and bladder functions, but at a delayed rate compared to children without cerebral palsy.
Managing Incontinence in Cerebral Palsy
Incontinence can negatively affect one’s quality of life.
It can be a burden to constantly worry about whether you need to use the bathroom or what to do if an accident occurs.
Luckily, there are ways to manage incontinence and minimize the frequency of bowel or bladder-related accidents.
Management for incontinence in individuals with cerebral palsy can include:
Following A Bowel and Bladder Management Program
A bowel and bladder management program involves sticking to a schedule where you empty your bowels or bladder at around the same time every day or so.
This helps create consistency but requires you to be conscious of your fluid intake and diet throughout the day.
Wearing A Diaper
While wearing a diaper may not be ideal, it’s better to be safe than sorry.
Especially if your child is just starting to follow a bladder/ bowel management program or taking new medications for their incontinence, wearing a diaper may be a good idea just in case an accident does occur.
For urinary incontinence, most people will take anticholinergic medications to relax their bladder muscles.
Managing bowel incontinence will typically involve antidiuretics or bulking agents.
Using A Catheter
A catheter is a narrow tube that drains urine from your bladder.
There are two types of catheterization:
The first is called intermittent catheterization, and it involves inserting the tube every 4-6 hours.
The other option is called indwelling catheterization, and it entails wearing a catheter at all times.
This option may be ideal for those who do not want to worry about how much they’re drinking and sticking to a schedule.
Getting Botox Injections
Botox can relax the bladder muscles by blocking the nerve signals that cause contractions.
It’s important to keep in mind that the effects of Botox are temporary and generally last 3-6 months.
Undergoing Bladder Augmentation Surgery
Just like its name suggests, bladder augmentation surgery expands the size of your bladder so that it can hold more urine.
This extends the time between trips to the bathroom and decreases frequency of bladder-related accidents.
Understanding Cerebral Palsy and Incontinence
It’s normal for young children to have bowel and bladder-related accidents, but as they get older, it can become problematic.
Symptoms and associative conditions of cerebral palsy like motor impairments, intellectual disabilities, and communication difficulties can contribute to incontinence.
Most children with CP learn how to control their bowel and bladder movements. They just might take a little longer, which is completely fine!
Hopefully, this article helped you better understand how cerebral palsy can affect incontinence and what you can do to manage it. Good luck!
Featured image: ©iStock.com/shironosov