Neurogenic bowel and continence programs for the individual with spina bifida.

The neurogenic bowel in the person with spina bifida has been difficult to manage. Current literature reveals very little research conducted on the outcome of continence programs in the person with spina bifida. It has different characteristics than the neurogenic bowel seen with spinal cord injury because it occurs during fetal development. Management of the neurogenic bowel to achieve continence is based upon thirteen assessment items that include stool form, individual physiologic parameters, family patterns, diet and medications. Programs are developmentally related to appropriately support the child's involvement. Continence strategies include the use of oral medication early in the day and timed sitting, suppositories or enemas later in the day at a time convenient to the family. The timing of the medications and evacuation is very important to the success. An interdisciplinary team is important in supporting the family as the child with spina bifida grows into an independent adult. The dietician and occupational therapist have invaluable insight into diet, fluids, adaptive aids and techniques that contribute to positive outcomes of the continence program.