Case Study: Spina Bifida
Introduction:
Myelomeningocele , commonly known as Spina Bifida, is a birth defect in which the spinal cord does not develop properly due to incomplete closure of the neural tube at 28 days of gestation. The overlying bones and skin are incompletely formed and the underdeveloped area of the spinal cord is exposed on the surface of the back. It is the most common multicomplex birth defect affecting the central nervous system that results in permanent disability . With advances in treatment modalities, technologies and scientific breakthroughs, persons with spina bifida in the US are living well into adulthood. Myelomeningocele management includes life -long comprehensive neurologic, urologic, musculoskeletal , skin and habiliation management.
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A frequent problem caused by neurogenic bowel is constipation. Hard stool causes a partial or total blockage of the large intestine. Diarrhea can occur when liquid stool leaks around the blockage. The rectal sphincter, innervated by S2, cannot be controlled making early initiation of a bowel management program essential since conventional toilet training is not successful for fecal continence. The goal of the bowel management program is to have a soft log shaped stool on the commode at a predictable time daily to every other day. This can be achieved with a combination of diet and medication.
Dietary recommendations include:
1. Fiber (at least 5+age up to 30 grams daily) either via fiber supplements, fruits, and vegetable.
2. Noncarbonated, Non-caffeine fluid (at least 4-8oz glasses up to age 4 then 8-8oz glasses daily after age 4)
Medication can be given as a combination. One medication is given orally to make the stool softer (laxatives, hyperomotics, osmotics) or increase the muscle contractures that move along the stool mass (stimulants) or Coats the bowel and the stool mass with a waterproof film (lubricants) and another rectally to promote expulsion of the stool, such as enemas and suppositories. Complete bowel clean out is required prior to the initiation of any program in order for the program to be
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