Bladder and bowel dysfunction is a common problem for children with myelomeningocele and related spinal-cord defects. The medical and social effects of this problem include incontinence, odor, breakdown of the skin, infections, social immobility, poor self-esteem, and sometimes refusal of entry into school, as well as the possibility of renal failure and death. These complex, chronic effects necessitate a multifaceted and multidisciplinary approach. The following aspects of management are reviewed: anatomy and physiology, developmental concerns, current treatment techniques, and psychosocial influences.