Toilet training and spina bifida

Potty training for the non-disabled child usually begins at around the age of 18 months to two years, and the child is usually ‘trained’ by day at around two-and-a-half years.

Every child is different and it is advisable to watch for signs in the child’s development which may suggest he/she is ready to begin potty training, such as: awareness that they are passing urine or having a bowel action, waking from naps with a dry nappy, asking to have their nappy changed.

For children with spina bifida, bladder and bowel continence should be addressed at the same time and the way the bladder works should be assessed in infancy in order to protect the kidneys from damage. This should be done before starting toilet training, and appropriate management should be in place.

Toilet training for a child with spina bifida is likely to be quite different from that of other children. Very often, damage to nerve pathways which coordinate the bladder and bowel function and promote the sensations, mean that control cannot be learnt in the usual way.

Toilet training should begin at around two years of age.

The toilet should be comfortable and not damage pressure areas (the skin on the buttocks and the backs of the legs).

The child should be able to place his/ her feet flat on the floor or a box/ plinth.

Equipment and adaptations

A young child with spina bifida may have difficulty balancing when sitting. The potty or toilet should provide a stable and secure position, with a comfortable, supportive seat.

If necessary, providing rails or something for the child to hold on to, can help to give stability to the upper body. Wherever possible, try the simplest solution first.

An occupational therapist should be able to give an assessment and help with equipment if your child has poor sitting balance, and with any other any equipment or adaptations which may help successful toileting.

A child who is using clean intermittent catheterisation can also be encouraged to sit on the toilet and pass urine, although it is not always necessary. It is essential to continue with the catheterising regime as well.

Bowel training

Bowel training depends on developing a habit of opening the bowels at roughly the same time each day and clearing a large amount from the bowels each time. Do not allow constipation to develop. Ideally, the faeces should be firm and formed.

Watch for times in the day when the child opens his/her bowels to see if a pattern emerges. The bowel is more active after meals, especially breakfast. Sit the child on the toilet at these times and encourage her/him to push down gently.

To encourage this, try tickling to get the child to laugh or the child could blow a party toy (not balloons and always under supervision) and the effects of gravity will also help. Even if there is no result, continue to sit the child on the toilet after meals. However, the child should not sit on the toilet for longer than 5 minutes.

Encourage the child to clean her/ himself with tissues and attend to clothing, as far as possible.

All programmes will involve sitting on the toilet even when there is no sensation (feeling) of a need for bowel action. If it becomes a normal part of the daily routine from early childhood, it is less likely to become a major issue later on.

If you are concerned about any aspect of toileting for your child, seek advice from your continence adviser, school nurse or Shine medical adviser.

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