Spina Bifida and Neurogenic Bladder
Bailey Carson, Jeffrey Watson, Cassie Lipe
University of Arkansas-Fort Smith
Spina Bifida and Neurogenic Bladder
Spina Bifida is one of the most common birth defects in the United States. It affects roughly 1,500 babies yearly (CDC 2018). Four types of Spina Bifida are known to be Spina Bifida occulta, cystica, meningocele, and myelomeningocele. This neural tube defect is usually accompanied by a secondary health issue known as neurogenic bladder. It is important to be aware of this birth defect and the surrounding issues that may arise. As healthcare providers, we must be educated on what Spina Bifida is, what known causes there are, treatment options for patients, family teaching, and expected outcomes patients may face with this defect.
According our textbook, Spina bifida is often used, “to refer to all neural tube disorders that affect the spinal cord.” However, there are multiple types with different amounts of spinal cord involvement. Spina bifida occulta is when there is a defect of the vertebral bodies without any of the spinal cord or meninges protruding. This type is very common, and children diagnosed with this will usually not require medical attention. Spina bifida cystica is separated into two categories. The less serious being meningocele, where the meninges herniate through a defect in the vertebrae. There are typically just minor or no associated neurological defects at all. Children with meningocele do require a surgery to correct the herniation. The more serious type, myelomeningocele, is the most severe form of neural tube defect, where the spinal cord often ends at the point of defect. Myelomeningocele may be diagnosed with an ultrasound and it is noticeable at birth. (Juarez, Fernandez, Ricci, Kyle, & Carman, 2017)
During the prenatal period Spina bifida can be diagnosed in a few different ways. Ultrasound can be used during the second trimester of pregnancy, starting around week 16-18. Another method of diagnosis is maternal serum alpha fetoprotein (MSAFP) screening. This process measures how much alpha fetoprotein is in the mother’s blood. There is a certain amount that circulates through the mother’s blood, but if the number is higher than that, it could indicate that child fetus has an “open,” or not skin covered, neural tube defect. This diagnosis route is not as effective though, because this is not selective for just Spina bifida, it also could show if the baby will have something like down syndrome. Also, the MSAFP screening requires a correct gestational date for an accurate reading. Some cases will go undiscovered until prenatally. When the baby has been delivered, if the diagnosis hasn’t already been made, Spina bifida occulta may be determined with an X-ray. The babies born with more severe Spina bifida will often show more symptoms like muscle weakness. Doctors can do CT scans and MRIs to view the spinal cord and vertebrae as well as look for any cerebrospinal fluid that might be on the brain due to hydrocephalus (CDC 2018).
The cause of Spina bifida is still unknown. According to the National Institute of Neurological Disorders and Stroke, scientists believe that it is not just one factor that influences this, but multiple factors working together. They believe genetic, nutritional, and behavioral factors all play a role in causing Spina bifida. However, research has shown that an insufficiency in folic acid in a mother’s diet is a key part of causing Spina bifida and other neural tube defects (CDC 2018).
A neurogenic bladder is something that sometimes occurs with Spina bifida. This means that the person lacks bladder control due to brain, spinal cord, or nerve damage. A neurogenic bladder can also be caused by multiple sclerosis, Parkinson’s disease, or diabetes. When the nerves that control the bladder are damaged, it can cause overactive bladder, incontinence, underactive bladder, or obstructive bladder (Urology 2018).
Treating spina bifida affects each person differently, depending on the type and severity. According to the CDC “No two people with spina bifida are exactly alike. Health issues and treatments for people with spina bifida will be different for each person.” (CDC). When treating spina bifida physicians closely look at what type of spina bifida the patient has. In most cases spina bifida is corrected with surgery once the baby is born however research and experimental fetal surgeries are starting to occur. Neurogenic bladder is usually a common secondary condition to spina bifida and is hard to control. Over the last few decades, surgeons have discovered ways to help with neurogenic bladder. The most common technique is using the mitrofanoff system. Basically, a surgeon will bypass a route to the bladder and create a stoma that will be more convenient for a client to self-catheterize themselves. Breakthrough surgeries such as these are essential to a better quality of life for people diagnosed with spina bifida with secondary neurogenic bladder.
Family teaching for Spina Bifida is very crucial and important for a patient’s stabilization and overall health once leaving the hospital. One teaching point a nurse would want to explain when a patient has the effects of neurogenic bladder is demonstrating to parents or age-dependent children to make use of an external urinary device (bedpan, urinal) or procedure steps for self-catheterization. Educate the parents on the characteristics of normal urine and that of a urinary infection. It is very important to teach the family and children how important everyday mobility is. SB patients can enjoy everyday activities and play time. Involving children in community programs, outside and recreational activities will help the child develop emotionally and help in the aid of maintaining an overall wellbeing.
When treating spina bifida, outcomes will be different depending on its severity. Nevertheless, the main goal is to ensure that the patient can live a normal life or as close to a normal life as possible. In patients with severe neural defects such as paralysis are going to need assistive devices such as wheelchairs, walkers, and specialized devices to assist with movement/walking. Regular rehabilitation is necessary for many who have spina bifida with diminished function. Main goals should be exclusively set to each individual patient, the key goal as stated before to ensure the best quality of life for each patient.
SB and Neurogenic Bladder is a very serious birth defect but it can be treated and normal living can still be achieved. If more people were educated about this defect maybe there would be greater care when dealing with patients with SB. When it comes to the nursing aspect of a diagnosis, every part of care is crucial to be aware of.
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