The signs and symptoms of spina bifida vary and depend on the type and location of the spinal opening that is characteristic of the condition. There are three main groups of symptoms: affected movement ability, urinary and bowel continence, and hydrocephalus.
Mobility and Paralysis
The central nervous system plays a vital role in the ability to control muscular movements, with the brain sending messages through the spinal cord to particular areas of the body. A child with spina bifida may have some damage to the nerves in the spine that carry these messages, resulting in difficulty of muscular movement control.
For this reason, it is common for patients with spina bifida to experience weakness, reduced sensation or paralysis of the lower limbs. It is more common when the location of the spinal opening is higher up the back, where the main nervous control of the lower limbs occurs.
There are several methods of support that may help a patient that suffers from limb weakness. For example, ankle supports of crutches can help to aid their ability to move. In more severe cases with paralysis, more extensive interventions may be needed, such as the use of a wheelchair.
As a result of the paralysis and weakness of the lower limbs, other related problems may present. Burns and pressure sores on the feet can occur due to the reduced sensation in the area. The muscles in the legs can be severely weakened, due to extended periods without being used adequately. In turn, this can affect the development of the bone and lead to dislocation or deformation of joint, or fractures of the bone. The spinal growth can also be affected, leading to a curved shaped spine known as scoliosis.
Urinary and Bowel Incontinence
The nerves in the spinal cord that are responsible for the control of the bladder and bowel may also be affected by spina bifida.
Under normal circumstances, they keep the muscles of the voluntary sphincters tightened closed, unless the individual relaxes the muscles to empty their bowels or bladder. For a patient with spina bifida, the control of these muscles can be lost, resulting in urinary and bowel incontinence.
Particularly the urinary incontinence usually requires medical intervention, as the slow dribble of urine that is common among affected individuals increases the risk of a urinary tract infection. On a chronic basis, this can lead to damage to the kidneys.
Both constipation and diarrhea can present periodically in patients that suffer from bowel incontinence. Many patients report problems with sexual dysfunction as a result of incontinence symptoms.
Hydrocephalus refers to excess fluid on the brain and can lead to damage in the area and a range of specific signs and symptoms, including:
- Short attention span
- Difficulty problem solving
- Difficulty reading
- Communication difficulty (e.g. understanding fast, verbal language)
- Organisation difficulty
- Difficulty in execution of visual and physical tasks
Despite these learning difficulties, most patients with spina bifida have normal intelligence.
Some infants may also be affected by Arnold Chiari malformation, due to the excess fluid pushing the lower lobes of the brain towards the spinal cord. This can lead to symptoms of irritability, drowsiness, vomiting, seizures and poor feeding.