VOIDING FACILITATORY MANEUVERS
Because you are not completely emptying your bladder and are harboring residual urine, it is necessary to make every attempt to empty your bladder as completely as is possible. This will minimize the potential development of urinary infections and irritative voiding symptoms that can occur when the bladder fails to empty. There are several means by which you can facilitate voiding:
Relaxation—In order to satisfactorily empty the bladder, the bladder muscle must contract (squeeze) at the same time that the sphincter muscles relax. The bladder neck and sphincter muscles are very much influenced by your state of mind. Anxiety and nervousness can cause the sphincter muscles to squeeze harder, making effective urination difficult. Thus, you must assume a relaxed state of mind; this can be facilitated by bringing some reading material to the toilet.
Double and Triple Voiding— These maneuvers refer to a second and third attempt to urinate after trying to empty your bladder as completely as possible.
Valsalva Maneuver—This is a medical term for straining the abdominal muscles in order to help empty the bladder. By bearing down and squeezing the abdominal muscles, the pressure within the bladder will be increased and voiding can be facilitated.
Crede Maneuver—This is a medical term for manual pressure on the lower abdominal wall in an attempt to better eliminate urine. This is best performed by using both hands, leaning forward, and pressing down firmly on the lower abdomen between the belly button and the pubic bone.
Suprapubic Tapping—This involves tapping rhythmically over the suprapubic area (between the belly button and the pubis) in an attempt to stimulate the nerve reflex that will trigger urination. This is not effective in every patient, but is certainly worth a try.
If the aforementioned maneuvers are not effective in eliminating residual urine, it may be necessary to either try medication to facilitate bladder contraction and sphincter relaxation or to start intermittent catheterization. You can easily be taught how to catheterize yourself four or more rimes a day as a means of completely emptying the urinary bladder. This is a highly effective method, but will only be considered if the above conservative measures fail.
Andrew L. Siegel, M.D.
Director, Center for Continence Care
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