People with spina bifida often have damage to the nerve supply to the bladder and bowel. The emptying of both may be erratic and uncoordinated, resulting in continence management problems.
A low fluid intake (in the mistaken belief that it will help to keep the person dry) and poor diet both add to the existing problem. It is important to keep drinking plenty and to have a diet rich in soluble fibre.
Dietary fibre can be found in many fruits, vegetables, grains and pulses. There are two types ‘insoluble’ (which stays undigested and helps keep matter moving through the bowel) and ‘soluble’ (which absorbs and holds on to water, keeping the stool soft). A glass of liquid, preferably water or diluted juice, should be taken alongside a fibre-rich meal, for the soluble fibre to absorb, as constipation can be caused by a high fibre diet and not enough fluids.
Some people find certain foods cause them to have diarrhoea or to be constipated. A food diary can help to identify foods which are causing problems so that they can be eliminated or replaced with a healthier alternative. Constipation may make a person moody, sluggish, or agitated and an impacted colon will push on the bladder causing urinary incontinence to worsen.
Poor mobility also adds to the problem of constipation and regular exercise should be encouraged.
Some medication used by children and adults with spina bifida, such as Oxybutinin and some anti-epileptic drugs, can cause constipation or can make existing constipation worse.
There are many ways of avoiding constipation, including a variety of medications, high bowel washouts, or surgical procedures such as the ACE (click here for more information on bowel and bladder procedures). However, establishing a regular toileting pattern early in a child’s life may mean none of these are necessary.
Babies and Children
Small babies can be given drinks of cooled, boiled tap water between milk feeds, once or twice daily, to help prevent constipation (especially in formula fed babies) and to maintain a good level of hydration. When weaning, slowly introduce a wide range of vegetables and fruit into the diet, adding pulses, e.g. peas, beans, lentils etc., after one year.
Drinks of water or very diluted juice, suitable for very young children, can be given between meals. It is not recommended to give juice in bottles as this can lead to tooth decay.
Small children should not be given extremely high fibre or extremely low fat diets, unless under medical instruction and supervision, as such diets are unlikely to contain enough calories and fat-soluble vitamins to promote growth and general good health. Rather, aim to promote the habit of eating fresh fruit and vegetables daily and avoid high fat snacks (chocolate, crisps, etc.) to prevent obesity. A balanced diet including protein, vegetables and carbohydrates should be encouraged.