How are facilitative techniques and maneuvers used in the treatment of bladder dysfunction?

Updated: Jan 04, 2019
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Various techniques are used to maintain continence or empty the bladder.

The Credé maneuver involves manual compression of the bladder; it is used in patients with decreased bladder tone or areflexia and low outlet resistance. Facilitation of the Credé maneuver by an attendant is useful, particularly in individuals who are quadriplegic. Increasing intravesical pressure also may be achieved through the Valsalva maneuver (ie, abdominal straining).

Reflex bladder contraction may be provoked by pinching or stimulating the lumbar and sacral dermatomal levels. This technique may be used in spinal cord injuries (SCIs) if there is no outlet obstruction or detrusor-sphincter dyssynergia.

A program of timed voiding is useful in patients with weak sphincters or patients with hyperreflexic bladders. These patients are put on a schedule of frequent bladder emptying before actual bladder contraction. Timed voiding should be scheduled every 2-4 hours.


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