Why can't Anna be potty trained?
The nerves that affect your ability to control the muscles that allow you to urinate (or to not urinate) are located low your spine. Spina bifida (very basically) means that a portion of the spine failed to close properly during development in utereo. Usually, the spine beneath the area that failed to close properly, along with the afflicted area of the spine, suffers some type of nerve damage.
Anna has the most severe form of spina bifida. Almost all people with this type of spina bifida cannot urinate on their own. They cannot feel anything and cannot control those muscles.
What exactly is cathing?
Catheterization (what we have shortened to "cathing") is the process of emptying the bladder with a catheter. The process that we follow for Anna is called intermittent catheterization. I think that sometimes there is confusion because most of us think of catheterization or have experience of catheterization where the catheter is in place for an extended period of time.
How do you cath?
Here is what a cath kit looks like.
Each kit contains the following:
- Disposable puddle pad
- Iodine swabs
- Sterile disposable gloves
- A small piece of gauze
- Straight-tip catheter in a bag
I put the gloves on and swipe Anna with the iodine swabs, which cleans the area with the intent of preventing an infection.
I then push the tip of the catheter out without touching it. Rich and I manipulate it through the bag. Again, the goal is to touch as little as possible. Because the catheter is entering her uninary tract and bladder, I don't want any germs to hitch a ride in with it.
Depending on how full her bladder is, it takes anywhere from a minute to three minutes (or so, not more) for her bladder to empty. After that, you simply pull out the catheter, wipe the iodine off of her with a baby wipe and we are done.
How often does Anna need to be cathed?
We cath Anna when she first wakes up and then every two and a half to three hours during the day. She is cathed again right before bedtime. We do not have to cath her overnight.
Where do you cath Anna?
We have learned to adjust to cathing Anna while out and about. We always cath her right before we leave the house and/or as soon as we arrive at our destination. If we are going somewhere like the zoo, we will cath her as soon as we arrive so that we don't have to stop an hour into our visit to cath.
I don't like to cath Anna in public restrooms for several reasons. First of all, people stare and she is reaching the age where she needs some privacy. Secondly, most public restrooms have the pull down baby changing stations. Anna is still small enough to fit on those but there is nowhere to place the cath kit except for on the floor, which makes cathing difficult and potentially unsterile.
When we cath Anna in the van now, we put a blanket (or coats) over the console between the two front seats and lay her down on the driver's seat and console. The person cathing sits in the passenger seat and spreads the cath kit across the dashboard. (Am I the only one who keeps old receiving blankets in her van? They serve many purposes!)
I do want to comment about Disney here. It was very easy to cath Anna during our Disney vacation. Each park has a baby center with changing tables. We would visit those whenever possible. If the walk was too far, I would cath her in the regular restroom. Instead of those stupid pull down changing tables, they have big counter spaces dedicated to baby changing.
Will Anna always need to be cathed?
The simple answer to this is yes. Unless there is some new type of surgery in her lifetime, which is possible, she will always have to use a catheter to empty her bladder. At some point, she will be able to cath herself. When she goes to school for longer days, the school nurse will have to cath her until she is able to learn how to do it on her own
Has cathing Anna always been this easy?
No. The first time the nurse cathed Anna to demonstrate to us how to do it, Anna flipped out. It took her (and us) a few days to calm down. The whole process was stressful in the beginning. It seemed like during those first few weeks, Grammy or I happened to be the ones cathing Anna. Rich finally had to jump in and say, "Hey, I need to do this too."
We have all learned and now it has become part of our daily routine.