Bladder and Bowel Training

BLADDER AND BOWEL
TRAINING
Thushara John
1st MPT
Bladder management
 Accomplished through various methods depending on patient’s
level of function, motivation, and cognitive ability to follow a
particular program of bladder care.
 The various methods are

1. Catheter- free voiding
2. Voiding with an external collection device
3. Long- term intermittent self- catheterization
4. Indwelling urethral catheterization
5. Suprapubic cystostomy
6. Urinary diversion by an ileal conduit
1. Catheter free voiding
 Indicated for patients who have the proper motivation,
hand dexterity, normal voiding pressures, and regular
drinking-voiding schedules.
 Contraindicated for patients who have UTI,
vesiocoureteral reflex, hydronephrosis, pyelonephritis,
and advanced kidney failure
 The patient should be free of general medical
problems, such as uncontrolled hypertension, severe
diabetes mellitus, autonomic hyperreflexia, DVT, or
severe coronary artery disease.
 1. ADHERENCE TO DRINKING- VOIDING-
CATHETERIZATION SCHEDULES.
 400ml with major meals
 200 ml at 10am, 2pm, 4pm
 No fluids after 6pm
 Voiding schedule- every 2-3hrs depending on bladder dysfunction.
 Catheterizations every 6 hrs
 2. PATIENT EDUCATION
 Anatomy of urinary system and basic information about normal micturition
and patients bladder dysfunction
 Instruct patient in correct drinking-voiding-catheterization schedule
 Signs and symptoms of UTI
 3. Three basic voiding techniques
A) LIGHT SUPRAPUBIC TAPPING
 Patient tap lightly with fingertips over suprapubic area of
abdominal wall
 To cause effective contraction of bladder muscle
B) STRAINING
 Provides an external force to compress the bladder and to open the
bladder neck
 Begin by placing one arm over the abdomen
 Leans forward with elbow resting on top of thigh
 Before straining take three quick breaths.
 Then take a deep breath and holds it and bear down firmly, while
pushing abdomen out against support of arm.
C) THE CREDE MANEUVER
 Compresses the bladder and opens bladder neck
 For effective crede maneuver, deep massage of bladder
with fingertips.
 Fistis made with dominant hand, placing it about an inch
below the naval
 Without holding one’s breath, the patient pushes the fist
into the abdomen toward the tailbone
 Patient leans forward and directs the push downward onto
bladder
2. Voiding with an external collection device
 Bladder management for men
 Condom type external device
 Indicatedfor patients who lack hand dexterity,
strength, and sitting balance to don and doff
pants.
 Disadvantages- skin breakdown of penis, UTI
 Have good skin inspection and hygiene
 Avoid twisting of condom, bending of tube
3. Long- term intermittent self- catheterization
Effectivefor patients with flaccid or

overstretched bladder.
Perform catheterization every 6 hrs
Continue to follow 1800ml fluid
schedule
4. Indwelling urethral catheterization
 Indicated in patients with severe cognitive impairement
after stroke or closed head injury and in seriously ill and
debilitated patients
 Complications- severe cystitis, injury to bladder by
catheter tip, bladder stone formation
 3000ml per day
 Catheter should be changed every 2 weeks
 Maintain urinary bag below bladder level to prevent
retrograde flow
 Taping is done to prevent accidental traction on catheter
5. Suprapubic cystostomy
Used for patients who have neurogenic

bladder dysfunction in association with
urethral injury or sepsis, severe urethral
strictures or other urethral complications
Management is same like indwelling urethral
catheter
6. Urinary diversion by an ileal conduit
Management for neurogenic bladder

dysfunction
Not used widely because of upper
urinary tract complications
Bowel management
 Acute phase
 Adynamic ileus is the most frequent GI complication in the

acute stage of neurogenic bowel dysfuction.
 Management is nasogastric suction
 Close monitoring of fluid balance with central IV line
 Gut peristalisis is stimulated by abdominal massage or TENS.
 As soon as bowel sound reappears, a clear liquid diet may be
introduced and regular bowel emptying program is
instituted.
 Chronic phase
 Doneon bedside commode as soon as sitting

balance achieves
 Regular fluid intake is important
 Diet should be high in protein, fiber, calories
 Milk
of magnesia is usually taken 8 hrs before
planned bowel care
 Patientswith lower motor neuron bowel dysfunction may
have much more frequent bowel movements because the
need to use crede manveur or straining for bladder
emptying.
 Encourage to have bowel action at the same time each
day.
 Maintain regular meal times
 Ifmedications are needed, first add bulk cathartics, then
surface agents, and finally more stimulating medications.
 Ifbowel movements has not been accomplished by any of
the above described measures, enema should be used.
 Biofeedback may also be tried if constipation is the
problem
References
1. Textbook of spinal cord injury
2. Rehabilitation medicine; principles and
practice

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BLADDER AND BOWEL

 The various methods are

Effectivefor patients with flaccid or

Used for patients who have neurogenic

Management for neurogenic bladder

 Adynamic ileus is the most frequent GI complication in the

 Doneon bedside commode as soon as sitting

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