1. Bladder and Bowel Management for children with complex health needs and life-limiting conditions Slides written by June Rogers MBE- Director of PromoCon Editor: Dr Penny Dobson MBE 2011

2. What this presentation will cover How continence is achieved Why things may go wrong Management options Sources of further information and support

3. Anatomy of gastric and urinary tract

4. Sequence of events for achieving continence Control of the bowel when asleep Control of the bowel when awake Control of the bladder when awake Control of the bladder when asleep

5. Achieving continence is the interaction of two processes Physiological maturation - ability to sit/walk/dress - maturation of bladder / bowel Understanding and social awareness - understands/responds to instructions - self esteem/motivation - desire to imitate/identify with peers - self determination and independence

6. 6 ICCS slide library v1 2010 Spinal pathways involved in micturition

7. What skills do children need for toilet training? The ability to sit on a potty A bladder that will hold onto wee for at least an hour or more A bowel that is not constipated Some awareness of being wet/soiled Some awareness of what toilet training is all about

8. What continence issues may children have? 1. Children who have life limiting problems from infancy may well have associated delayed toilet training, as well as other bladder/bowel issues, so for some of these children the expectation may be that toilet training will never be a viable option 2 Children who have acquired problems – either through accident or illness (e.g. brain damage as a result of an accident or cancer) or have a degenerative disease such as muscular dystrophy – may have previously been toilet trained but may now have either lost that ability completely or have changing continence needs

9. What problems may children have? Bladder problems: Wetting/incontinence Inability to empty the bladder Bowel problems: Constipation Faecal incontinence