Bladder Exstrophy: Treatment and Outlook

Many pediatric urological complications can happen before, during, and after childbirth. Some of them are more serious than others, and some are more easily treatable. Bladder exstrophy is one of those conditions that affect the child as they are developing in the womb. Luckily, there are reconstructive procedures that can repair this congenital abnormality so that children can grow up and enjoy most of the same activities as others.

What is Bladder Exstrophy?

Bladder exstrophy is a developmental abnormality that happens when the lower abdominal skin does not properly form, causing the bladder and part of the urethra to be exposed to outside elements. The bladder is essentially turned inside out when the muscle and skin do not correctly close around it. The inner lining of the urethra is exposed on the top of a boy’s penis or between the separated left and right halves of the clitoris in girls.

Due to the bladder and urethra not being closed properly, the bladder cannot hold urine. Urine continuously leaks out and onto the exposed bladder and the surrounding skin. Bladder exstrophy is slightly more common in boys than girls.

How is Bladder Exstrophy Repaired?

A child born with bladder exstrophy requires some form of immediate treatment after birth. First, the bladder and urethra need to be protected from diaper material with a transparent adhesive dressing. Each child will be different when it comes to a specific plan of treatment that the primary care physician, pediatric urologist, and the urology health care team devise.

There are also different options for the repair; immediate or delayed. Immediate reconstructive surgery will be performed within the first two to three days of a child’s life, whereas delayed surgery will be around six to twelve weeks of age. Sometimes the delayed choice is preferred due to the small anatomy of a newborn. Allowing the body to develop more might be a safer repair option.

Bladder exstrophy reconstructive surgery usually involves multiple operations at different times in a child’s life as they mature to obtain the best results.

Initial Closure and Pubic Bone Repair

The first surgery is either done immediately after birth or delayed at approximately six to twelve weeks. This procedure closes the bladder, abdominal wall, and posterior urethra and reconstructs the belly button and pubic bone repair. Because the pubic bone is separated and spread widely apart in children with bladder exstrophy, correcting this abnormality when the bones are soft is more successful. Bringing the pubic bones closer together helps support the soft tissues of the pelvis.

Babies are put into a device, so their lower legs do not move. This device helps prevent the separation of the pelvic bones and aids in recovery.

Repair of the Urethra

If the initial surgery was delayed, this procedure could be combined with the first at approximately six to twelve weeks of age. The bladder should have increased in size at this point, and the urethra is closed and rerouted through the usual passageway. The ureters may be repositioned within the bladder if they are not connected in the right place.

Common Problems Associated with Bladder Exstrophy

Children with bladder exstrophy can experience problems at any stage of life after their surgical repairs are complete. Often, lifelong follow-up care is needed to help ensure the best quality of life.

Urinary Incontinence

Since the pelvic bones are spread widely apart in a child with bladder exstrophy, there is inadequate support of the soft tissue of the pelvis. Because of this lack of support, there is increased tension on the pelvic bones, leading to involuntary urinary leakage.

Vesicoureteral Reflux

When the ureters are not joining the bladder in the correct place, urine can flow back toward the kidneys. This backflow can lead to kidney damage and recurring urinary tract infections.

Emotional Issues

A psychologist or licensed therapist may need to be considered part of the child’s health care team. They can help the child and the family deal with complex issues together.

What are the Risks Involved with Bladder Exstrophy Surgery?

Wound Site Problems

There is a risk that the wound site will not heal properly and open up, causing the bladder to move out of position. Another surgery is required to repair this problem.

Kidney Damage

The other risk is kidney damage from vesicoureteral reflux when urine flows back into the kidneys. If this condition is left untreated, it can lead to kidney failure.

As with any surgical procedure, there are some risks. However, the health care team will monitor both of these conditions throughout the child’s treatment plan.

What is the Long-term Outlook for Babies Born with Exstrophy?

Children born with bladder exstrophy can live a happy and productive life with an average life expectancy. Many people have a normal sexual function and can have children of their own. Some males with bladder exstrophy may experience fertility issues. However, there are many treatment options available for that and can be discussed with a doctor.

Intermittent Catheterization or Urostomy Surgery Later in Life

little ones urostomy pouchDuring a child’s journey with bladder exstrophy, there may come when they are unable to empty their bladder on their own completely. In this case, the health care team can determine if the use of pediatric intermittent catheters might be an alternate approach. If a more long-term drainage solution is needed, a urostomy can be surgically created as an alternate opening for access to the urinary system. The child will then have complete control over urine flow from their body using an ostomy pouching system with a drainage tap.

Most children with bladder exstrophy go about their daily lives without anyone ever even knowing what is different underneath their clothing. They participate in sports and other activities much the same as any other child. The success stories are endless from families that have had a child undergo bladder exstrophy surgeries.

For any questions related to incontinence products, intermittent catheters, ostomy supplies, or any other product that we carry to manage medical conditions, our Product Experts are available to assist. Our compassionate and knowledgeable team will make it easy for you to choose the right products for your needs so you can get back to doing the things you enjoy most.

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Multiple Sclerosis and Incontinence

Multiple Sclerosis and incontinence often are experienced together. The central nervous system controls many functions throughout the body, such as walking, thinking, and controlling various muscles. Multiple Sclerosis can cause damage to the central nervous system and produce a variety of symptoms, including vision loss, muscle stiffness, or even bladder and bowel dysfunction.

What is Multiple Sclerosis?

mend and women exhibiting different symptoms of multiple sclerosisMultiple Sclerosis (MS) is an autoimmune disease that affects cells in the central nervous system. For those with MS, not only is their immune system defending harmful bacteria and viruses again, but it is also attacking their body. Electrical signals are sent throughout the body by the central nervous system to control almost everything we do, and MS disrupts these electrical signals.

Those with MS can experience a wide range of symptoms, and this disease affects everyone differently. Although most of the symptoms are not visible to others, some are and can worsen over time.

Common Symptoms of MS

  • Walking problems
  • Vision problems
  • Bladder and bowel dysfunction
  • Fatigue
  • Cognitive difficulties (attention, learning, and memory)
  • Mood changes
  • Muscle stiffness
  • Numbness and tingling
  • Pain in arms and legs
  • Hot and cold sensitivity
  • Weakness or poor coordination

How Multiple Sclerosis Can Affect the Bladder and Bowels

There is a coating on the nerve endings called the myelin sheath that protects the nerve cells. When the myelin sheath is damaged due to multiple sclerosis, electrical impulses transmit to the brain much slower. This nerve damage affects how the body interprets signals between the brain and the bladder and bowel. Coordination of the muscles that control holding and emptying the bladder and the bowels is disrupted, leading the incontinence.

Bowel or fecal incontinence can result from weak sphincter muscles from MS or can be from constipation. When a person is constipated from MS, it can be from the medication or lack of mobility and lead to overflow incontinence.

Some of the various types of incontinence a person with Multiple Sclerosis may experience are:

Overflow Incontinence

When the bladder does not fully empty, urine can leak. Those with overflow incontinence from MS are unable to squeeze the muscles needed to empty the bladder due to nerve and muscle damage.

Urge Incontinence

When a person feels a sudden urge to use the restroom and has to rush to get there, they are experiencing urge incontinence. The nerves linked to the bladder have been damaged with MS and cannot communicate quickly enough to the brain.

Stress Incontinence

When usually going about your day and having an unintentional loss of urine, you experience stress incontinence. You may also notice this leakage when you sneeze, cough, laugh, or lift something heavy. The pelvic floor muscles have weakened from MS, so stress incontinence is often experienced.


When you are not emptying the bowels as often as you usually would is one of the signs of constipation. Some medications can often cause constipation that lasts for days and be very painful. Abdominal bloating, decreased appetite, and fatigue are all signs that you may be constipated, and you should speak to your doctor about treatment.

Fecal Incontinence

Fecal incontinence or bowel incontinence is when a person cannot control regular bowel movements. When the sphincter muscles are damaged from multiple sclerosis, the ability to delay emptying the bowels is disrupted.

Treatment Options for Incontinence Related to Multiple Sclerosis

Treatment options are available to help improve incontinence for those with multiple sclerosis. There are many conservative methods. However, if those are not effective, then there are medications available. If incontinence symptoms are more severe, you may be recommended surgery as a last resort to improve your quality of life.

Conservative Treatments for Incontinence

Diet and Lifestyle

Bladder and bowel health is critical when it comes to incontinence. Eating a well-balanced diet that consists of fiber and plenty of fluids can help with regular bowel movements and avoid constipation. Fluids like carbonated beverages, caffeine, and alcohol can irritate the bladder, so it is best to avoid them.

Establishing a Routine

Establishing a routine can help to avoid accidents. It might help to go to use the bathroom every few hours and after every meal. Keeping a pattern of eating and drinking at the exact times can also help. In the evening, make sure to have your last drink two hours before bed. This practice may help avoid an overnight accident.

Retraining the Bladder or Bowels

Bowel retraining and bladder retraining is a treatment for incontinence that can work well for those with persistent diarrhea, constipation, or nerve damage due to MS. With bowel retraining, the goal is to aim for consistency of the stool and regularity of the movements. Gradually increasing the time between bowel movements, you are retraining the sphincter muscles, which may help make it easier to hold on.

When retraining the bladder, this process also involves gradually increasing the amount of time between each visit to the bathroom. Both bowel and bladder retraining takes time and patience. Many people find that keeping a Bladder Journal or Bowel Journal can help. This journal can also be shared with your doctor to determine a treatment plan.

Incontinence Products

Assortment of incontinence productsToday, there are many incontinence products on the market that are designed to address light to severe urinary or fecal incontinence. These incontinence products can help provide more comfort, security, and protection for your clothing, bedding, furniture, and auto.

Incontinence products are available in a wide variety of absorbency levels, sizes, and styles. And, these products are offered for all genders and ages. Some of the categories include:

  • Incontinence Protective Underwear resemble regular underwear and offer more traditional and discreet protection.
  • Incontinence Briefs are also called adult diapers with refastenable tabs. This incontinence product is a more secure and absorbent option.
  • Incontinence Liners and Pads are generally used for light to moderate incontinence and are inserted into regular underwear as an added layer of protection.
  • Incontinence Belted Undergarments are much longer than a typical pad and feature a belt for additional security.
  • Incontinence Bed Pads, Underpads, and Chux are an excellent option to protect everything from your bed, furniture, car seat, or use as a puppy potty training pad.
  • Incontinence Clamps are used to help treat urinary incontinence in men. This device blocks the flow of urine. Many men use them to control urinary incontinence after prostate surgery, obesity, old age, or those who have diabetes.

Visit our Incontinence Product page for more information and to order these products. Our caring, specially trained Product Advisors can help you decide which option is most suitable for you.

Intermittent Catheters

collage of intermittent and Foley cathetersWhen a person cannot fully empty their bladder independently, they may be given the option to use an intermittent catheter.  By using an intermittent catheter, it can help eliminate overflow incontinence. A thin, flexible tube is into the urethra to drain urine out of the bladder. All catheters are designed to be sterile, one-time-use, and require a valid prescription from a physician. There are various types of catheters available, and depending on your unique needs, your doctor will know what is best for you.

Foley Catheters or Indwelling Catheters

Depending on the circumstance, a Foley catheter or indwelling catheter is inserted into the bladder and remains there for either a short or prolonged period. A balloon filled with sterile water is incorporated near the tip of the catheter tube. Once the catheter is inserted and inflated, this balloon prevents the Foley catheter from slipping out of place. Typically, a leg bag or urine drainage bag is connected to this type of indwelling catheter.

Percutaneous Tibial Nerve Stimulation

A treatment method that directly stimulates the nerves responsible for bladder and bowel control is called Percutaneous Tibial Nerve Stimulation (PTNS) and can treat incontinence. The tibial nerve is near the ankle, and during PTNS, a small needle connected to a stimulator device is inserted at this point. Impulses travel up the spine and target nerves in the spinal cord to retrain the bladder and pelvic floor muscle function. Some MS patients have found this helpful.

Using Medicine to Treat Incontinence


Sunmark ClearlaxMultiple sclerosis can leave some immobile, which can lead to constipation and ultimately overflow incontinence. Over-the-counter laxatives are available to help treat incontinence and come in various options such as suppositories, powders, and liquids. Laxatives are usually fast-acting to provide relief for irregularities. Make sure to you speak to your doctor or pharmacist about which type of laxative is best to use.

Antidiarrheal Medication

Antidiarrheals work to slow down the production of loose stool or diarrhea. Over-the-counter medications such as Imodium are available for purchase to help with the discomfort of repeated liquid bowel movements. However, it is essential to note that an underlying issue causes diarrhea, and these medications may offer only temporary relief.

Anal Irrigation and Enemas

Anal irrigation or rectal irrigation is a method that involves emptying the bowel by using a specialized pump, water, and irrigation tube. Anal irrigation is an effective alternative to conservative treatments like suppositories and laxatives. Anal irrigation can help manage chronic constipation and fecal incontinence.

Enemas are a quick, easy, and fast-acting treatment used to clear impaction from severe constipation. Using enema products involves administering a solution such as water and sodium phosphate to clear the bowel.

Antispasmodic Medications

Spasms of the bladder muscle can often be treated by the use of antispasmodic medications. These medications work to relax the muscles of the gut. They can help reduce urge incontinence associated with MS. Antispasmodic medications belong to a group of medicines known as antimuscarinic or anticholinergic drugs. A doctor must prescribe these medications as they are not suitable or safe for some people.

Injectable Therapies

Injectable therapies are available as a treatment that includes the non-surgical injection of a “bulking” material into the urethra to improve leakage. This material thickens the tissues, which then prevents soiling and improves bladder control.

Surgical Treatments for Incontinence

Suprapubic Catheters

As an alternative form of long-term catheterization, a suprapubic catheter can be used to treat incontinence. This type of catheter involves a minor surgical procedure to place a tube directly into your bladder through your abdomen. The suprapubic catheter can then be attached to a leg bag or urinary drainage bag to collect urine. It can be more comfortable than a Foley catheter and may be less likely to cause infection.


Botox is a potent neurotoxin that causes muscle paralysis by blocking the electrical impulses to a nerve. This type of incontinence treatment is relatively new in terms of treating an overactive bladder. If all other medications have failed to improve your condition, Botox may be a considered treatment by your doctor.

Bladder Augmentation

If medications and conservative treatments have failed to treat your incontinence, your doctor may discuss a bladder augmentation surgery may be an option. There are several ways this operation can be performed, but it is considered major surgery and involves cutting the bladder open. If you consider this option with your doctor, it is essential to ask as many questions as possible and take notes of your conversation.

Sacral Nerve Stimulation

Sacral Nerve Stimulation or Sacral Neuromodulation (SNM) can help restore normal bladder or bowel function by addressing the communication between the brain and the bladder and bowel. A device is implanted under the skin in the upper buttock. This device helps correct the messages that run along the nerve pathways that may be causing incontinence symptoms. As with other incontinence surgical treatment options, it should only be considered after medication and conservative incontinence treatment options have been exhausted.


For those with Multiple Sclerosis and incontinence, if fecal incontinence is severe, constipation is brought on from immobility, or dexterity issues have developed, your doctor may recommend a bowel diversion in the form of a colostomy. A small incision is made in the abdomen, and a section of the colon is pulled to the surface, forming a stoma. The stoma is an artificial opening that an ostomy skin barrier and ostomy pouch attaches to for waste collection. Colostomies may be temporary or permanent, so this treatment is typically considered in severe cases where all other treatment options have failed.

Where to Buy Incontinence Products

shop on Personally Delivered website, save an additional 5%, earn 3% cash back at teh end of the year based on purchasesWe carry a wide variety of incontinence products at Personally Delivered by many trusted brands like Attends, PBE Tranquility, Prevail, First Quality, Depend, and more. Incontinence is not the same for everyone, and that is why we have Product Advisors to help you navigate the purchasing process based on your unique needs.

Not only do we offer a wide range of incontinence products by absorbency, size, and style, we can help make it easy for you to get the products you need to be delivered right to your door when you need them. With our Automatic Delivery Program, you will save an additional 5% on each shipment and get 3% back at the end of the year. There is no commitment, it is hassle-free, and you can cancel at any time.

What Resources Are Available for Those Affected by MS?

For those affected by Multiple Sclerosis and incontinence, there are many resources available.

Multiple Sclerosis and incontinence often go hand-in-hand, but as you can see, there are many options available for treatment. We are here for all of your incontinence needs at Personally Delivered. If you need assistance choosing the right incontinence products for your unique situation, our Product Experts are just a phone call away.

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