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.
Constipation is very common in people with Spina Bifida. The nerve damage to the bowel means the time taken for food to move through the gut is slowed down. Because of this slowing down, the faeces stay in the large bowel (colon) for longer than is normal and this allows more fluid to be absorbed from the bowel, causing the stool to become harder and harder.
Sometimes the stools become impacted; the colon then expands and pushes against the bladder, adding to problems with bladder continence.
More mucus is produced by the swollen bowel and this mucus is stained by the stool. Bacterial activity also causes it to smell. It then leaks out of the anus and is often mistaken for diarrhoea – this is called ‘overflow’.
If the colon and rectum remain swollen for too long they function less well. The colon may lose all elasticity and form a floppy reservoir which may then be extremely difficult to empty completely. The anal sphincters (the muscles which keep the bottom closed) may suffer damage and the anus will remain open and leak constantly. (In some people with spina bifida the anal sphincter already does not work properly because of nerve damage).
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).
Children and adults need a varied and balanced diet which contains 20-40gms of fibre daily. 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. Read the labels on packaging for fibre information.
Some people find certain foods cause them to have diarrhoea or to be constipated. Milk, eggs and refined foods, such as white bread, may contribute to constipation. Grapes, sweetcorn or food and drink containing caffeine (tea, coffee, cola, chocolate) or very fatty foods, can cause diarrhoea. 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 (in a wheelchair or otherwise) 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 (see information sheet on ACE: Antegrade Continence Enema). However, establishing a regular toileting pattern early in a child’s life may mean none of these is 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) to prevent obesity. A balanced diet including protein, vegetables and carbohydrates should be encouraged.