Supporting continence in children and teenagers with cerebral palsy (plain language)
Some children and teenagers with cerebral palsy (CP) may need extra support with bladder and bowel control. This is called continence.
Continence means being able to control when you wee or poo. Some children and teenagers with CP may develop these skills later or need ongoing support.
What can affect bladder and bowel control?
Many things can affect continence. These include:
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movement and muscle control
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communication
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learning
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constipation
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how the bladder works
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medicines
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pain or tiredness
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getting to and using the toilet.
Bladder and bowel problems can affect comfort, confidence and taking part in school and social activities.
Bladder control and urinary incontinence
Urinary incontinence means having trouble controlling wee. It can happen sometimes or more often.
Different types include:
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Overactive bladder or urge incontinence: A sudden or frequent need to wee. The child or teenger may leak before reaching the toilet.
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Stress incontinence: Leaking when coughing, sneezing, laughing or exercising.
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Overflow incontinence: The bladder does not empty fully. This can cause leaking or dribbling.
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Functional incontinence: Your child or teenager may find it hard to reach or use the toilet. This may be due to movement, clothing, transfers, communication or access.
Daytime wetting can also be linked to constipation, urinary tract infections, stress or changes in routine. Big changes, such as starting high school, may also have an impact.
Constipation and bowel problems
Bowel problems can include constipation, soiling or difficulty doing a poo.
Constipation is common in children and teenagers with CP. Many things can contribute, including:
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how the gut moves
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reduced movement
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tight or weak muscles
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food and fluid intake
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some medicines
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pain when doing a poo
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difficulty sitting comfortably and safely on the toilet.
Constipation can cause:
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tummy pain or discomfort
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poor appetite
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feeling sick or vomiting
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soiling
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urinary tract infections
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more difficulty controlling the bladder
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problems with how some medicines are absorbed.
Keep track of bladder and bowel patterns
Keeping a record can help you understand what is happening.
You can record:
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how often your child or teenager wees
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how often they do a poo
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when accidents happen
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whether poo is hard or painful to pass
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whether your child avoids using the toilet.
When to talk to a health professional
Talk to your healthcare team if you have concerns about your child's bladder or bowel control.
The right assessment can help the team understand what is happening and what support may help.
Your child's support team may include:
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a continence nurse
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a paediatrician
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a urologist
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an occupational therapist
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a physiotherapist
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a dietitian
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a psychologist
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school support staff.
What can a continence plan include?
Every young person is different. A continence plan can be matched to your child or teeneger's needs.
It may include:
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regular toilet routines
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support to manage constipation
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drinking enough fluid and eating enough fibre
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comfortable and safe toilet seating
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equipment or changes to clothing
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communication supports
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A plan for accessing toilets at school
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pelvic floor exercises, when suitable
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medicines or other treatment, when needed.
Some children and teenagers may need specialised treatment. This can include bladder medicine, biofeedback training or surgery. An appropriate health professional will usually assess the child before these options are considered.
Supporting your child's independence
The goal of continence support is to help your child or teenager feel comfortable and respected.
The right support can also help children and teenagers build independence and take part at home, at school and in their community.
