Toilet Training the Child with Neurogenic Impairment of Bowel and Bladder Function

Abstract

A descriptive study of the rate of learning socially acceptable (independent and dependent) bowel and bladder management for the child with myelodysplasia was done. All those children born with myelodysplasia and being followed in an interdisciplinary clinic were included (N = 525). Ages ranged from birth to 18+ years. They were classified into one of three categories according to the level of their lesion: a) sacral, b) low lumbar, or c) high lumbar or thoracic. Data were analyzed by the Breslow and X² statistical techniques. The children with high lumbar and thoracic level lesions acquired independence more slowly than those with lower level lesions (p =. 0008). Development of independence was started for children with low lesions as early as 4 to 7 years of age; however, it was not until 10 to 11 years of age for those with high lesions. By 7 to 9 years of age, 50 percent of the children with low lesions had achieved socially acceptable urine collection but were still dependent for stool collection; they became totally independent for both urine and stool collection by 11 to 12 years of age. In contrast, only 40 percent of the children with high lesions had learned independent toileting skills by 17 to 18 years of age (at the end of the study). Delay in independent urine care was attributed to complexities of both clean intermittent catheterization and application of penile and stomal collection devices. Those children with impaired intellect were the slowest to acquire self-toileting skills (p =. 08). The rate of learning toileting skills was not affected by the presence of lax or weak anal tone, abnormal upper extremity function, the child's sex, or age on entering our program.