Bladder and bowel management in physically disabled children

Management of the bladder and bowels in children and young people with physical disability has advanced significantly over recent years. Its importance goes beyond achieving full continence, although that has huge importance to the individuals and families concerned. Management of the bladder now strives to achieve a functional and safe urinary tract. This will protect the kidneys from urinary tract infection and avoid the devastating long term problems of renal failure. The investigation of children known to have neurological disability starts early. Regular review of bladder function is important. Medical management is regularly enhanced by active surgical management. The use of bladder augmentation and Mitrofanoff procedures can significantly improve symptoms and the quality of life in young people. Active management of the urinary tract is coordinated with bowel management for full continence. Regular bowel movement ensures good absorption and healthy growth. There are clear NICE guidelines to treat constipation. The surgical management in children with neurological impairment is also very successful. The Antegrade Continence Enema (ACE) is well tolerated and reliable.It is important to try to actively manage the bladder and bowel in all children with disability. Even children with quite significant levels of physical disability can achieve full continence and quality of life and general health may be improved in all.