Introduction
Cerebral palsy is a neurological condition that consists of a group of disorders that affect the development of movement and causes a limitation in a person’s activity. This makes it difficult for the person to maintain their balance and posture. This condition arises due to damage to the developing brain or due to abnormal development of the brain, thereby affecting the person's ability to control their muscles.
What Are the Signs and Symptoms Seen in Cerebral Palsy?
The signs and symptoms of cerebral palsy are seen differently from person to person. This condition either affects a person’s whole body or is limited to one or two limbs or a side of the body. The signs and symptoms usually include problems with speech and eating, movement and coordination, development, and other systemic issues.
Problems With Movement and Coordination-
-
The common movement disorder includes spasticity, which is exaggerated reflux and stiff muscles.
-
Muscle tone variations like being too floppy or too stiff.
-
Lack of muscle coordination and balance.
-
Involuntary movements which are jerky or tremor-like.
-
Crawling favoring towards one side of the body, like dragging a leg or reaching with one hand.
-
Walking difficulties like a crouched gait, scissor-like gait, walking on toes, asymmetrical gait, or a wide gait.
-
Fine motor skills difficulties like picking up utensils or buttoning their clothes.
Problems With Speech and Eating-
-
Delayed speech development.
-
Difficulty in speaking, chewing, sucking, or eating.
-
Problems in swallowing or excessive drooling.
Problems With Development-
-
Delay in reaching the motor skill milestones like crawling or sitting up.
-
Intellectual disabilities and learning difficulties.
Other Problems-
-
Problems with vision and difficulty in hearing.
-
Bladder and bowel problems.
What Are the Urological Conditions Associated With Cerebral Palsy?
The urological conditions associated with cerebral palsy include phimosis, retractable testicle, cryptorchidism, hypogonadism, hypospadias, and an overactive bladder.
What Is Phimosis?
Phimosis is a condition that occurs in children and adults who have not circumcised their penis. In this condition, the foreskin cannot be retracted back, and the penis will look like it has rings around its tip. Phimosis is not necessarily a problematic condition. However, it becomes a problem when it starts showing symptoms. When infected, the symptoms mainly include swelling, soreness, redness or discoloration, pain during urination, and pain during sexual activity or erections. Based on the severity, the problem may be treated with a gentle retraction. Sometimes, a steroid ointment also helps in softening the foreskin, thereby making the retraction easier. Severe cases may require circumcision or similar surgical intervention methods.
What Is a Retractable Testicle?
A retractile testicle happens when the testicle moves to and fro between the scrotum and the groin area. The main sign of this condition is the absence of one or both testicles from time to time. These testicles can be moved to the scrotum without pain and will stay there when the cremaster muscle is fatigued. In most cases, the retractile or retractable testicle need not be treated. It will automatically descend into the scrotum on its own without any requirement for medical intervention. When retractile testicles ascend and become undescended testicles, they might require surgical intervention.
What Is Cryptorchidism?
Cryptorchidism, also called undescended testicles, occurs when the testis fails to drop to its normal position in the scrotum. This condition is seen in about three to four newborns out of 100 newborns. Within the first three months of life, the testicles will drop on their own. However, if the testicles do not drop after three months of age. This is the reason one out of 100 boys with an undescended testicle requires treatment. Undescended testicles are often confused with retractile testicles. This can be assessed by a pediatric urologist who will note the difference with a physical examination. The testicles would not drop after three months of age. Hence surgery is the only treatment choice. Surgical intervention is recommended after six months of age.
What Is Hypogonadism?
Hypogonadism happens when the gonads (sex glands) of the body produce very little or no hormones. The gonads of men are testis, and women are ovaries. The symptoms of hypogonadism in women include irregular menstruation, complete stopping of menstruation, mood swings, and hot flashes. The symptoms of hypogonadism in men include growth problems, breast enlargement, muscle loss, and low libido (decreased interest in sex).
Hypogonadism is managed by hormone-based medicines like progesterone and estrogen for women, which come as a skin patch in the form of a pill. Testosterone is used for men and is given in the form of a skin gel, skin patch, patch applied into the upper gum area, solution applied into the armpit, or through injections. Many forms of hypogonadism are usually treatable.
What Is Hypospadias?
Hypospadias is a congenital condition (birth defect) where the urethral opening is present in the underside rather than at the tip of the penis. Urethra is a tube present in the body which drains and is the outlet for the urine from the bladder. The signs of hypospadias include a downward curve in the penis, abnormal spraying while urinating, and because the top half is covered by the foreskin, the penis appears in a hooded way. This condition is usually diagnosed soon after birth while in the hospital. Certain forms of hypospadias are minor and do not require any surgical intervention. The treatment usually involves surgery to reposition the opening of the urethra and some cases straightening the penis shaft.
What Is an Overactive Bladder?
Cerebral palsy and incontinence happen alongside each other. It was noted that 85 percent of cerebral palsy patients have an overactive bladder. Cerebral palsy causes abnormal muscle spasticity and muscle tone, which affects the muscle that controls the bowel and bladder movements. When the muscles involuntarily contract, muscle spasticity occurs.
Whenever the bowel or bladder muscles fails to contract, the body retains waste products causing urinary tract infections or constipation. Difficulty in controlling the urine is the most commonly encountered incontinence in cerebral palsy. An overactive bladder can be managed by medications like Tofranil and incontinence training that involves making the person stick to a schedule to empty their bowel and bladder at the same time daily.
Conclusion
The urinary tract difficulties associated with cerebral palsy include urinary incontinence, hesitancy in voiding, incomplete emptying, urinary frequency, and recurrent urinary tract infections. Urological conditions associated with cerebral palsy include hypospadias, phimosis, cryptorchidism, retractable testicle, and hypogonadism. The health care practitioners will resort to different methods and help manage the urological conditions and urinary difficulties faced by a person with cerebral palsy to assist in improving their quality of life.
