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Management of Urinary Incontinence

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Unlike fecal incontinence, urinary incontinence impacts on other organ systems. Incontinence caused by a neurogenic bladder may be associated with recurrent urinary tract infections and vesicoureteric reflux. This combination can result in ongoing damage to the

kidneys, resulting in renal failure [27]. Consequently, the early aggressive management of these patients is important to prevent renal damage. The important factors are to ensure that the bladder is emptied regularly and that the intravesical pressure remains low. Bladder emptying, when necessary, is best performed by clean intermittent catheterization (CIC). CIC can be performed either urethrally or via a Mitrofanoff stoma [6,24]. In the majority of patients with an ARM the urethra is sensate, consequently urethral CIC can be uncomfortable, especially in the older patient. By starting in the first 3 months of life, Boemers found a higher compliance rate [6]. Reducing bladder pressure should first be attempted medically using anti-cholinergic agents; when this fails, bladder augmentation may be necessary. These techniques can be used to achieve social continence in many of the patients [6].