Multidisciplinary Management of Bladder and Bowel Dysfunctions in Children and Adolescents with Pediatric Acquired Brain Injury


Giovanni Mosiello


Costanza Candeloro
Maria Luisa Capitanucci
Claudio Cini



Acquired brain injury (ABI) in children is quite common. In severe ABI children are often operated and admitted to an intensive care unit (ICU). During the emergency phase children are commonly managed with an indwelling catheter, that ie removed after the acute phase when patient is admitted in a neurorehabilitation department. Incontinence, urinary and fecal, are common long-term sequelae in ABI. However bladder and bowel functions are considered commonly a secondary problem respect to more serious physical injuries. For this reason incontinence is often neglected for weeks or months after ABI, due to striking disabilities, while in a global process of rehabilitation also continence should be considered. Incontinence is highly relevant as well as mobility considering the patient's quality of life, school social activities and affective relationship.

The purpose of this symposium is to present how to recognize and to manage neurological bladder and bowel dysfunction in children after ABI, considering the importance of an individual rehabilitation project, single patient related. Motivation and patience are asked to all in the treatment of incontinence in ABI children either to health care professionals, either to care givers, parents and patients, anyway is crucial that health care professionals have specific knowledge in order to define a correct therapeutic program, in order to avoid severe disabilities, due to incontinence, and in some cases renal function impairment, because a diagnostic delay and uncorrect treatment.The majority of patients are still treated only with diapers or indwelling catheters for bladder, as enema for bowel dysfunction, not considering the different clinical situation that can be related to ABI. Diagnostic tools will be presented considering the role of no invasive and invasive studies, diaries and questionaires.The correct use of anticholinergic, clean intermittent catheterization, cistostomy, in acute phase, as well as the role of botulinum toxin, button cistostomy, surgery, modulation and complete bowel management, will be presented. Finally a long-term program will be presented.

Presentation of the Symposium

  1. Claudio Cini :The life after ABI, a child in a Rehabilitation Unit. The importance to define a global and correct rehabilitation project.
  2. Maria Luisa Capitanucci:The neurogenic bladder and bowel: the different clinical patterns, diagnostic tools and the first line treatment
  3. Giovanni Mosiello:The severe incontinence: second line treatment, and new treatment
  4. Costanza Candeloro: Long-term management of neurogenic bladder and bowel dysfunction in a global neurorehabilitation program
  5. Question and answer
  6. Closing remarks


Learning Objectives:

  1. Describe the relevance to define in children a global rehabilitation project for all disabilities related to ABI, including bladder and bowel dysfunctions.
  2. Indicate the most appropriate diagnostic test to evaluate bladder and bowel dysfunction in children of different age in short, medium and long-term management after ABI.
  3. Use in the different clinical situation the most appropriate treatment for bladder and bowel dysfunction according, age, neurological status, coexisting disabilities: pads, clean intermittent catheterization, urotherapy, neuromodulation, enema, endoscopic and surgical treatment.