Spina bifida - Symptoms of spina bifida

Spina bifida can cause a wide range of symptoms that can be grouped into three general categories.

This includes:

• cognitive symptoms, such as difficulty reading or solving problems
• mobility symptoms, such as paralysis and muscle weakness
• bladder and bowel symptoms, such as bowel incontinence and urinary incontinence

These are described in more detail below.

The severity of the symptoms usually depends on where on the spine the opening occurs and whether the baby also develops hydrocephalus (excess fluid on the brain).

An opening at the top of the spine is more likely to cause paralysis of the lower limbs and mobility difficulties, compared with openings in the middle or at the base of the spine. And the baby is more likely to have learning disabilities if he or she develops hydrocephalus.

Cognitive symptoms

Problems with the development of the neural tube also affect the development of the brain. The brain may not develop properly, leading to learning and other cognitive problems.

The cortex (the outside layers of the brain) may be thinner than usual, leading to difficulties with memory, organisation and concentration. The cerebellum may also be affected. It is the part of the brain thought to be responsible for important cognitive functions including language processing and physical co-ordination.

Abnormal brain development may also include a type 2 Arnold-Chiari malformation, where lower parts of the brain are pushed downwards towards the spinal cord.

Further brain damage can occur if hydrocephalus places excess pressure on the brain.

About six out of 10 children with spina bifida will have normal intelligence, although just over half of these will have some type of learning disability, such as:

• a short attention span
• difficulty solving problems
• difficulty reading
• difficulty understanding some spoken language, particularly fast conversations between a group of people 
• difficulty organising activities or making detailed plans
• difficulty with visual and physical co-ordination, for example tasks such as tying shoelaces or fastening buttons

Read more about children with a learning disability.

Mobility symptoms

The brain controls all the muscles in the body with the nerves that run through the spinal cord. Any damage to the nerves can result in problems controlling the muscles.

Most children with spina bifida will experience some degree of paralysis in their lower limbs. If a child with spina bifida is partially paralysed, they may need to use ankle supports or crutches to help with their mobility. In cases of more severe paralysis, the child will require a wheelchair.

Paralysis can also cause other, associated problems. For example, as the muscles in the legs are not being used regularly, they can become severely weakened. As the muscles support the bones, this weakness can affect bone development. This can result in:

• dislocated joints
• misshapen bones
• abnormal curvature of the spine (scoliosis)

Read more about paralysis.

Bowel and bladder symptoms

As well as controlling your limbs, the nerves that run through your spinal cord also control your bowel and bladder. They help to control the muscles that keep urine in the bladder and stools in the bowel (sphincter muscles). The bladder muscle may be very tight or twitchy, and only store a little urine. If left untreated this can lead to kidney and bladder damage.

Most people with spina bifida have limited or no control over their sphincter muscles and experience urinary and bowel incontinence without appropriate management.

Urinary incontinence can take the form of a constant slow dribble of urine from the bladder.

If a child has bowel incontinence, they may experience periods of constipation (inability to empty their bowels). This can then be followed by episodes of diarrhoea (loose, watery stools) or soiling due to stools overflowing from the bowel.

Read more about bowel incontinence and urinary incontinence.