Neuropathic bladder and intermittent catheterization: social and psychological impact on families

Abstract

Clean intermittent catheterization (CIC) is the mainstay of management in neuropathic vesicourethral dysfunction, both to improve continence and, more importantly, to preserve renal function. We looked at the effects of this procedure on children, adolescents, and their families. In particular, we wished to see if there were any differences between those who successfully catheterized and those who did not. Forty families were enrolled into the study. Ages of children and adolescents (23 females, 17 males) ranged from 1 to 20 years. Most participants (n=31) had spina bifida. Other causes of bladder dysfunction included transverse myelitis, spinal cord injury, and spinal neuroblastoma. Parents were assessed using the Effects of Handicap on Parents semi-structured interview, the Socioemotional Functioning Interview, and a semi-structured interview, specifically designed for the study, which looked at family characteristics and experience related to diagnosis and catheterization. In addition, the Rutter Parental 'A' Scale Questionnaire was used to screen for emotional and behavioural disorders in the child. Results showed that CIC by carer or self-catheterization itself did not cause major emotional and behavioural problems but the bladder problem may act as a focus that puts considerable strain family relationships. Although most parents disliked CIC they complied with the suggested management. It is important that all those involved understand the aims of management and success can be achieved by combined input from medical, psychological, and specialist nursing staff. The problem is lifelong and continued support from a multidisciplinary team is essential.

Parental stress and support of parents of children with spina bifida in Uganda

“…The responsibility and anxiety around incontinence has a social and psychological impact on families (Borzyskowski et al . 2004). In our study, parents pointed out that catheterisation interfered with their lives, as they sometimes had to make extra trips to school to assist in catheterisation.…”

Predictors of parenting stress in mothers of children with spina bifida

“…Indeed even when the procedure is taken over by the child, many parents find that the responsibility of ensuring that their child complies with the schedule of CIC and the anxiety this produces remains with the parent. 16,17 Rendeli et al 18 have shown that parents of non-continent spina bifida children had significantly lower quality of life scores (parental emotional category) when compared with those of continent spina bifida children. However, their study did not analyse the CIC subgroup (17 of the 26 incontinent children had CIC done by a parent) per se.…”

“…Other problems that have been reported by parents performing CIC include an aversion to catheterizing their child, pain inflicted on insertion of catheter (in some children) and reluctance of the child to be catheterized. 16,17 Furthermore, the need for strict adherence to its regular timing and daily schedule leads to the feeling of 'life being dominated by it' and affects the caregiver's free time and social life. Parents have reported making extra trips during school-break to attend to their child's CIC.…”

Urodynamic Parameters Development and Complications of Clean Intermittent Self-Catheterization in Chinese Schoolchildren with Neurogenic Underactive Bladder

“…A possible reason is that the schoolchildren in the present study had the physical and mental capabilities to use CIC. Moreover, parents paid more attention to supervising the correct CIC of their children due to the adequacy of the educational, supportive and follow-up system [18,19] . Furthermore, the motivation was important for the successful use of CIC, as it ensured compliance and adherence to the CIC protocol.…”