Urinary Tract Issues and CP:
On May 18, 2013 The Weinberg Family CP Center in NY held a conference for professionals and families about cerebral palsy. Part of the conference focused on issues surrounding continence and urodynamics. Urodynamics is the study of the how the lower urinary tract (the bladder and urethra) functions. This part of the conference was led by Mr. Andrew Combs, RPA and Director of Urodynamics and Incontinence at NY Presbyterian Hospital.
Here are some of the highlights of his lecture:
Mr. Combs would like to see urinary tract care in CP become more proactive than reactionary.
For the CP population urinary assessments are often considered less important because incontinence is seen as a quality of life issue rather than a health concern. Often incontinence in the CP population is widely attributed to diminished cognition or simply an inability to achieve continence, rather than a potential dysfunction of the urinary tract. As a result urinary tract care is often reactionary instead of proactive. The majority of children with CP that are seen by Mr. Combs are brought in by parents concerned about continued incontinence and/or ongoing infections rather than physician referral.
Here are some stats he shared about individuals with CP:
70-80% issues with incontinence
85% have bladder overactivity
Types of bladder dysfunction:
-abnormal compliance (can’t get bladder to void etc.)
-inability to control contractions
-lack of coordination or dyssynergy between bladder and sphincters during voiding-this DSD drives dysfunction and increases pressure leading to problems
-low outlet resistance leading to leakage
Potential consequences of bladder dysfunction:
-incomplete emptying or urine retention
-structural damage to bladder
There are several approaches which are available for treating bladder dysfunction in the CP population. They include pharmacological, catheterization, and biofeedback techniques. The earlier problems are identified and addressed, the better the outcomes and possibilities for preventing increasing problems in the urinary tract.