Other conservative bladder methods
Tapping and expressing
Tapping and expressing, a procedure that is no longer recommended, was previously used to manage upper motor neurone (UMN) bladders, sometimes in combination with a sphincterotomy (particularly in male patients).
‘Tapping’ involved tapping over the pubic area, to stimulate spasticity and activity with the detrusor, to promote emptying of the bladder. ‘Expressing’ the bladder was initiated by applying pressure over the pubic area, to assist with drainage once a stream was initiated. This method needed to be completed a few times throughout the day to allow complete emptying of the bladder, which is more difficult to achieve in a wheelchair. In addition, an external drainage device (urinary sheath) was used, which made the method only suitable for males.
This procedure is no longer recommended, due to the risks with incomplete emptying, detrusor changes from overdistension, the need for sphincterotomy and potential ureteric reflux.
Other issues with this method include skin irritation, from sheath usage, and issues with application due to reduced penile length.
Valsalva or Credé manoeuvre (straining)
The Valsalva or Credé manoeuvre is a technique that may be used by people with incomplete upper motor neurone injuries (UMN) or lower motor neurone (LMN) injuries. This method isn’t considered voiding, as it isn’t controlled and requires straining to commence urine flow. It is easy to differentiate between an active and assisted void with patterns of urinary stream (intermittent and inconsistent flow), versus an inability to stop and start urine flow on demand.
This method isn’t recommended due to the increased risk of complications such as:
- Urinary and/or faecal leakage
- Vaginal and/or rectal prolapse especially with LMN injuries
- High intra-vesical pressure in UMN injuries and increased risk for long-term complications of the renal tract.