Bowel and Bladder Investigations and Procedures

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Urine Tests (also called Urinalysis) 

Urine Culture and Sensitivity (laboratory testing) - This is where a sample of urine is taken to see if there are any harmful bacteria (germs) growing in it. The same sample can be used to find out what antibiotics will kill the bacteria (sensitivity).

Blood Tests

Blood consists of plasma in which the blood cells are suspended. The most numerous cells are the red blood cells which help carry oxygen around your body. About a hundredth of the cells are white cells, their main job is to fight infection. Blood is taken for the following tests: 

  • Full Blood Count (FBC) 
  • C-Reactive Protein
  • Erythrocyte Sedimentation Rate (ESR) 
  • Urea and Electrolytes (U and E)

Imaging Tests

Urodynamics

Urodynamics means the study of the pressure and flow of urine in the lower renal tract, (the bladder, and the tube through which you pass urine, called the urethra). 

A Urodynamics study helps to determine if current treatment is working, or if changes need to be made. The objective of a Urodynamics study is to reproduce complaints or symptoms. 

Video Urodynamics may provide additional information that helps to further understand the problem.

Non-invasive or Simple Urodynamics

This test is done to evaluate urine flow and usually with a full bladder. 

The child will be asked to pass urine into a machine that looks like a toilet which can measure the rate at which the urine flows and the amount passed. At least two free voids (wees) are necessary to understand the flow pattern. 

Also, some hospitals stick patches on the outer thighs and buttocks to measure muscle contractions while urination takes place.

Invasive Urodynamics

This test requires the insertion of a catheter (into the bladder). 

A suprapubic catheter is normally inserted under anaesthesia 24 hours before the urodynamics study is done. The catheter is used to fill and empty the bladder, and also to measure pressure in the bladder and urethra. Another catheter is passed into your rectum (back passage); this measures abdominal pressure. When the test is finished the catheters are removed.

Bladder Scan

This measures the bladder volume, and can indicate whether the bladder is large or small. It is a non-invasive procedure which uses ultrasound waves. Gel is put on to your tummy and a small smooth instrument is pressed over the skin.

Cystogram

This is an x-ray examination where dye is put in the bladder through a catheter. This can be done to detect reflux (backward flow) of urine from the bladder up the ureters to the kidneys and urethral outline.

Clean Intermittent Catheterisation (CIC)

If timed toileting does not lead to dryness, CIC and drugs are needed. 

CIC involves inserting a small plastic tube into the bladder to drain urine. It is usually done every three to four hours. If using CIC with drugs does not result in dryness, surgery may be needed when the child is physically and emotionally ready. 

Please see the Catheterisation page for more details.

For further information and support contact your SBHI Family Support Worker who can put you in touch with SBHI's Continence Advisor if necessary.

Mitrofanoff 

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This operation was designed to help people who are incontinent of urine or cannot empty their bladder completely via their urethra. 

Your surgeon will explain the details of the procedure, how it works, and what will happen after the operation, both in the short and long term.

To create a Mitrofanoff stoma, the surgeon will take your appendix and connect one end to your bladder and the other end to the wall of your abdomen (tummy), either into the navel or lower down below the level of most underwear. 

This small opening (stoma) is used to pass a tube called a catheter along the new channel into the bladder so it can be emptied. 

If you have already had your appendix removed, don't worry. There are other ways of making a Mitrofanoff channel. One way is by using a tiny segment of small bowel. Some people also have their bladder enlarged at the same time as having the Mitrofanoff.

Bladder Augmentation

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You may have had bladder augmentation mentioned to you by your urologist as an option for managing your continence. You may be offered this operation because you need to pass urine very often, or feel an urgent need to pass urine. You may have recurrent infections, and your urologist may be concerned about your kidney function. The operation is offered after other, less invasive treatments, haven't worked.

Bladder augmentation operations have been used for a number of years now to improve the situation for people with this type of bladder problem (hyperreflexic bladder). By adding a piece of clean small intestine, the bladder capacity can be increased and the tightness of the bladder muscle can be reduced.

A bladder augmentation operation is major surgery with a hospital stay of around 10 days. The recovery period is long too; expect not to feel fully well for around three months. 

During the operation, your surgeon will make a cut along the top of your bladder, to form an opening like a clam shell (it is referred to as a clam cystoplasty). Into this space, a length of your small bowel, which has been cleaned, will be sewn to form a large patch, so the bladder will be larger and able to hold more urine. The contractions of this altered bladder will also be reduced, so the high pressures within the bladder, which can harm the kidneys, will be prevented.

After this surgery you will need to self-catheterise, even if you didn't need to before, as the bladder will now not be able to contract strongly enough to empty. You may find a Mitrofanoff (a tube opening the bladder on to the abdomen which you catheterise better); if you have had problems catheterising in the past, because it is too uncomfortable, or you can't reach easily, talk to your surgeon before your augmentation. Your surgeon may tighten up the bladder neck to prevent leaking if you have a Mitrofanoff as well. This will mean you need to remember to catheterise yourself regularly; if you are worried about forgetting to do this, talk to your surgeon before the surgery. You can also talk to your SBHI Family Support Worker who can put you in touch with our Continence Advisor as there are aids such as vibrating wristwatches which can help.

Artificial Urinary Sphincter - AUS

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What is it?

The Artificial Urinary Sphincter (AUS) is a surgically implanted device for controlling urinary incontinence which has been in use since 1972. If the bladder is difficult to manage and urine continues to leak, the urologist may decide that an AUS is necessary. 

An AUS is fitted either to strengthen a small part of the urethra, or to squeeze a small part of the bladder neck. The device is made from silicone elastomer - a synthetic (non-latex) rubber, so the body isn't likely to become sensitive to, or reject the material. It has three main parts: a cuff, a pump, and a balloon. All three parts are connected by silicone tubing.

How is it fitted? 

The AUS is surgically implanted through an incision (cut) in the lower abdomen. In males, an additional incision is made just behind the scrotum on either the left or right side. The AUS is hidden inside the body with the balloon in the abdomen and the pump in either the left or right scrotal sac in males, or the labia in females. The cuff, which holds a small amount of water, is inflated and then gently wrapped around the urethra.

How does it work?  

The inflated cuff applies gentle pressure to the urethra, helping to hold the urine in the bladder, and thereby improves continence. The pump has a soft curved end which can easily (and gently) be pressed to shift the water from the cuff to the balloon. 

When it is time to urinate (wee), the pump is pressed, and the pressure is released, relaxing the sphincter so the urine is free to be drained. The bladder can then be emptied by whatever means are normally used, for example, clean intermittent catheterisation (CIC). After a few minutes the fluid returns to the cuff, and the pump returns to its original shape. The bladder once again becomes continent.

Antegrade Continence Enema - ACE 

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Many people who have Spina Bifida will suffer with problems of constipation and faecal incontinence. The Antegrade Continence Enema, or ACE, is a way of managing bowel emptying at a convenient time each day, and should reduce both constipation and soiling episodes. 

The procedure involves sitting on a commode or toilet whilst a washout is given through a small opening or stoma on the abdomen. Because creating an ACE stoma requires an operation, the doctor will usually recommend it only when all other efforts to manage the bowel have been tried and have failed.

How does it work? 

To create an ACE stoma, the surgeon will cut off the appendix, still with its blood supply, and connect one end to the large bowel and the other end to the wall of the abdomen at the navel or lower down below the level of most underwear. This small opening (stoma) is used to pass a tube called a catheter into the bowel so that fluid can be introduced to flush faeces out through the anus. This is called an ACE washout. 

For people who have previously had their appendix removed, there are other ways of making an ACE stoma. For example, a tiny segment of small bowel may be used.

Colostomy, Ileostomy, Urostomy, and Vesicostomy 

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What is an ‘ostomy’?

This information is an introduction to having an ostomy, and should be used as a brief guide to having a stoma, or ostomy. 

‘Stoma’ simply means opening. A stoma allows access to the bowel or bladder via an opening on to the abdomen. 

The contents of the bladder (wee) or bowel (poo) then empty into a special bag that sticks on to the abdomen (tummy), and fits around the stoma. This is emptied or changed regularly as necessary. A stoma is one way of managing continence, but usually other methods would be tried first. Stomas may be temporary or permanent.

Colostomy

A colostomy is where a small part of the colon (large bowel) has been surgically diverted onto the surface of the abdomen. The waste passed is usually fairly solid. This is the usual type of bowel stoma seen in neuropathic conditions such as Spina Bifida. 

A neuropathic bowel is one where the messages sent from the brain to the anal sphincter are not received because the network of nerves (the spinal cord) is damaged. This can be a very good method for people to manage their bowels independently. Particularly if care issues pose a challenge.

Ileostomy

An ileostomy is where a small part of the ileum (small bowel) has been diverted on to the surface of the abdomen. An ileostomy will work more regularly and the waste will be more fluid. This type of stoma is less common in neuropathic conditions such as Spina Bifida.

Urostomy

A urostomy is where the ureters, the two small tubes that drain urine from the kidneys to the bladder, are diverted onto the surface of the abdomen. These tubes are so tiny that they have to be transplanted into a small piece of bowel which forms the stoma. The urine drains continuously into a special bag (appliance) which is then emptied regularly.

Vesicostomy 

A vesicostomy is where the bladder is diverted through a small opening directly onto the surface of the abdomen. This operation is only carried out in babies where the kidneys are under pressure and at risk of damage. A bag is not necessary because the urine drains straight into the nappy. This is always a temporary stoma.

Looking after the Stoma

Whilst you are in hospital, the nurses will teach you to look after your stoma. They will teach you how to empty and change the stoma bag and how to care for the skin around the stoma. 

There are many different stoma bags, and your stoma nurse will help you to find the one that is best for you. Your nurse will also explain how to store your stoma bags at home, and how to dispose of them.

You will be given some bags to take home and after that further supplies are available on prescription. You can then get the products from your local chemist; or you can use a home delivery service if you find it more convenient. This service won't cost you anything. 

You won't have to pay prescription charges for stoma products, but if you are over 16 years old or under 60 years old you will need to apply for a Prescription Exemption Certificate. You can get a form to apply for this from your doctor or chemist.

If you have a stoma or are considering surgery, contact your SBHI Family Support Worker who may be able to put you in touch with other people who have had a stoma operation, they will be a useful source of information, advice, and support.

 

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