Bladder Managment for Adults with Spinal Cord Injury - 20

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

1. Consider the use of Credé and Valsalva for individuals who have lower motor neuron injuries with low outlet resistance or who have had a sphincterotomy.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

4. Advise individuals with SCI of the potential for complications with Credé and Valsalva, such as: Incomplete bladder emptying. High intravesical pressure. Developing and/or worsening vesicoureteral reflux. Developing and/or worsening hydronephrosis. Abdominal bruising. Possible hernia, pelvic organ prolapse, or hemorrhoids.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: The use of Credé and Valsalva to empty the bladder may be appropriate in individuals with lower motor neuron injuries in which the bladder is flaccid and there is low outlet resistance. In this setting, Credé or Valsalva can manually empty the bladder. Emptying is more difficult if there is bladder outlet resistance or obstruction. Silent complications of the upper tract are not uncommon with this technique and should be routinely monitored (Chang et al., 2000; Giannantoni et al., 1998). 2. Consider avoiding Credé and Valsalva as primary methods of bladder emptying.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: Credé and Valsalva increase bladder pressure but do not empty the bladder effectively. Complications are frequent (Chang et al., 2000; Giannantoni et al., 1998). Individuals may experience inguinal hernias or prolapsed rectum due to excessive abdominal pressure. 3. Consider avoiding Credé and Valsalva methods in individuals with: Detrusor sphincter dyssynergia. Bladder outlet obstruction. Vesicoureteral reflux. Hydronephrosis.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: Credé and Valsalva increase bladder pressure but do not empty the bladder effectively and can lead to complications from both high intravesical and abdominal pressure. Complications are frequent (Chang et al., 2000; Giannantoni et al., 1998; Weld and Dmochowski, 2000; Weld et al., 2000; Zermann et al., 2000).

Indwelling Catheterization
Indwelling catheterization is a method of bladder management in which a catheter is inserted into the bladder and maintained in place for an extended period of time. Because there is an open conduit to the storage device, as bladder filling occurs, urine is continually emptied. Successful indwelling catheterization does not require bladder contractions, nor does it require coordinated action of the sphincter mechanism. Because complete bladder filling often does not occur and individuals who use indwelling catheterization tend to have uninhibited bladder contractions, bladder capacity and compliance tend to decrease over time. Indwelling catheterization can be accomplished by inserting a catheter through the urethra or by surgically placing a suprapubic catheter into the lower abdomen cephalic to the pubic bone. Although the care of and complications relating to both types of indwelling catheters are similar, a suprapubic catheter is less traumatic to the urethra and offers the possibility of genital activity with less preparation and fewer complications. Indwelling catheterization is used in any individual with acute central nervous system trauma because it allows precise monitoring of urinary output, especially when maintaining fluid balance is critical. Additionally, indwelling catheterization is

Rationale: During Credé and Valsalva voiding, there is an increase in intraabdominal and intravesical pressure, which may worsen hydronephrosis or reflux in the face of the bladder outlet obstruction or detrusor sphincter dyssynergia (Chang et al., 2000; Giannantoni et al., 1998). Increased intraabdominal and intravesical pressure increases sphincter activity and therefore detrusor sphincter dyssynergia. Hydronephrosis, vesicoureteral reflux, incomplete bladder emptying, urinary tract infections, and renal stones are potential complications of this method (Chang et al., 2000; Giannantoni et al., 1998; Weld and Dmochowski, 2000; Weld et al., 2000; Zermann et al., 2000).

Bladder Managment for Adults with Spinal Cord Injury

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