Spina bifida is a congenital neural tube defect that affects the spinal cord and surrounding structures. It may present with physical disabilities, but often overlooked are the urological complications, including neurogenic bladder, urinary incontinence, bedwetting, and an increased risk of recurrent UTIs and kidney damage.
With early diagnosis and care from specialists like Dr. Sadashiv Bhole, children with spina bifida can lead healthy, dignified lives with preserved kidney function and improved continence.
What is Spina Bifida?
- A birth defect in which the spinal column doesn’t close completely during fetal development
- Leads to varying degrees of nerve damage affecting bladder, bowel, and leg function
- Types include:
- Spina Bifida Occulta (mildest, often hidden)
- Meningocele (fluid sac with no spinal tissue)
- Myelomeningocele (most severe – spinal cord protrudes through the back)
Children with myelomeningocele almost always have bladder dysfunction.
Urological Problems in Children with Spina Bifida
The spinal nerves that control bladder and bowel function may be affected, leading to a condition known as neurogenic bladder.
Common complications include:
- Urinary incontinence (day and night)
- Bedwetting despite age-appropriate development
- Urinary retention or incomplete emptying
- Recurrent pediatric UTIs
- Foul-smelling urine and painful urination (dysuria)
- Hydronephrosis and reflux (VUR)
- Kidney scarring or failure in severe cases
Bladder issues are progressive—early intervention is critical.
Diagnosis and Evaluation
A child with known or suspected spina bifida should undergo early and regular urological evaluation:
- Urinalysis & urine cultures – for infection screening
- Ultrasound of kidneys and bladder – detects hydronephrosis or post-void residual
- Urodynamic studies – measure bladder pressure, compliance, and coordination
- VCUG (Voiding cystourethrogram) – checks for reflux or outlet obstruction
- MRI spine – to assess tethered cord or worsening spinal defect
Monitoring is typically lifelong to prevent upper tract damage.
Management of Urological Issues in Spina Bifida
Care is multidisciplinary and personalized. Goals include bladder safety, dryness, and kidney preservation.
Clean Intermittent Catheterization (CIC)
- Teaches child/parents to empty the bladder every 3–4 hours
- Prevents UTIs, urine retention, and kidney damage
Medications
- Anticholinergics (e.g., oxybutynin) to relax overactive bladder
- Antibiotics if recurrent UTIs are an issue
- Newer agents (mirabegron) in select cases
Surgical Interventions
- Bladder augmentation – for poor bladder compliance
- Mitrofanoff procedure – creates a catheterizable channel
- Botox injections – for bladder overactivity
- Urinary diversion – in very complex or non-salvageable cases
- Spinal surgery (if tethered cord or worsening neurological symptoms)
Daily Care & Long-Term Goals
- Toilet training guidance
- Diet and hydration for bowel control
- Regular bladder scans and urine testing
- Family education and psychological support
- Physical therapy for mobility if needed
When to Consult a Pediatric Urologist for Spina Bifida
You should schedule an appointment if your child:
- Has been diagnosed with spina bifida or tethered cord
- Experiences frequent UTIs, daytime wetting, or bedwetting beyond 6 years
- Shows signs of foul-smelling urine, incomplete voiding, or straining
- Has hydronephrosis or bladder wall thickening on ultrasound
- Faces difficulty with catheterization or poor bladder compliance
Children with spina bifida are at high risk of urinary tract complications that can silently damage the kidneys. But with early and proactive care by a pediatric urology specialist, most can stay dry, infection-free, and kidney-safe for life.
Book a consultation with Dr. Sadashiv Bhole, Nagpur’s trusted expert in pediatric bladder and neuro-urology, for comprehensive care tailored to your child’s needs.
