19 Anxiety and a fear of pain (justified or not) can hamper the learning process. It is important to discuss fears and how they can be overcome. Additional psychological support may be used if available. 21 In children with non-neurological disorders who cannot relax their pelvic floor sufficiently when inserting and removing the catheter, teaching pelvic floor relaxation exercises may be helpful. Additional help from a paediatric pelvic floor physiotherapist, where one is available, may also be very useful. In children with both neurological and non-neurological disorders, additional pelvic floor physiotherapy aimed at relaxation can also be helpful in overcoming anxiety related to catheterisation.21 In the case of bladder spams, the urine must always be tested for the presence of an infection and treated with antibiotics where appropriate. If there is no infection or spasms, it is sometimes necessary to prescribe anticholinergics. … Recommendations LE GR For irritation caused by the catheter: if necessary, use additional lubrication and/or a catheter with a different coating, a different thickness, or different stiffness 4 C In case of vacuum suction, try using a catheter with a larger Charrière or placing the finger on the end of the catheter during removal 4 C For children with non-neurogenic disorders, it can be helpful to do pelvic floor relaxation exercises when inserting or removing the catheter. Additional paediatric pelvic floor physiotherapy can also be helpful 4 C In children with both neurological and non-neurological disorders, additional paediatric pelvic floor physiotherapy can be helpful 4 C In the case of bladder spasms: check the urine and if necessary, prescribe antibiotics; anticholinergics are sometimes needed 4 C 4.3.3 Constipation and faecal incontinence Constipation and faecal incontinence can affect the success of a self-catheterisation program. Severe constipation can put pressure on the urethra, making insertion and drainage more difficult. It is, therefore, important to pay attention to bowel function. Faecal incontinence can make it difficult to maintain good hygiene. Children may also find it difficult to adequately wipe away stool after a bowel movement, which can increase the risk of urinary tract infection. For these reasons and social reasons, it is important to address both bladder and bowel continence simultaneously wherever possible. Bowel management may consist of a high-fiber diet and adequate fluid intake, laxative therapy, and in some instances, rectal irrigation or ACE procedures can be considered. It should also be noted that a potential side effect of anticholinergic therapy (commonly used in children with neuropathic bladder) is constipation. … Recommendations LE GR Before starting catheterisation in a child, evaluate bowel function and where necessary apply additional interventions or consult a specialist 4 C Be aware that social continence can only be achieved if both bladder and bowel function are treated, and discuss this with the child and caregivers 4 C
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