Intermittent catheterisation in children September 2016 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..23 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 programme. Severe constipation can put pressure on the urethra making insertion and drainage more difficult. It is therefore important to pay attention to bowel function26,47 Faecal incontinence can make it difficult to maintain good hygiene. This, and the fact that children may also find it difficult to adequately wipe away stool after a bowel movement, can also increase the risk of urinary tract infection. For these reasons and for social reasons it is therefore important to address both bladder and bowel continence simultaneously wherever possible 26. Bowel management may consist of high fibre 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 (common 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 4.3.4 Cognitive Ability Teaching self-catheterisation to children is affected by both the age of the child and its level of cognition. In the first instance, the teaching method and the information should be adapted to the child's age and ability. Impaired cognition can affect insight, motivation, compliance and long term independence. It should also be recognised that some children may be appear verbally competent but have significant cognitive impairment for example with children with hydrocephalus. Inadequate assessment can severely hamper the learning
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