Choosing the method of bladder management
Choosing the method of bladder management
When choosing the method of bladder management, there are many factors that can influence a person's ability to manage the bladder and whether the person will be independent or require assistance. Factors that can influence decisions on bladder management are:
Hand function
- Does the person have enough grip strength to hold and pass a catheter?
- Can they open catheter wrappers?
- Can they open the tap on the leg bag? Is there a style or modifications to make it easier?
Dressing Skills
- Are they able to dress and undress independently and in a timely manner?
- Can they move clothing to access a drainage bag?
Bed mobility
- Can the person roll, sit themselves up and manage bedding and clothing to perform intermittent catheterisation?
Sitting balance
- Is the person able to reach outside their base of support to set up for an intermittent catheter?
- Can the person balance on the front of the cushion in the wheelchair to do an intermittent catheter?
- Can the person lean forward to access the tap on the urine bag and/or reach to empty the bag into a toilet?
Transfer ability
- Can the person transfer onto a toilet?
- Are they able to adapt the transfer technique to varied bathroom environments?
Muscle tone and spasticity
- Does spasticity and tone present a challenge in being able to perform any tasks related to the selected bladder management?
- Does spasticity affect the ability for the person able to maintain a position to perform a catheter?
- Does a full bladder increase spasticity or tone and impact the ability to pass a catheter?
- What is the person's potential bladder capacity? Is it limited by detrusor spasticity?
- Does the person experience detrusor sphincter dyssynergia (DSD)?
Bladder sensation
- Is bladder sensation good enough for the person knowing when to void or if the bladder has been completely emptied?
- Does the person experience urinary urgency? This may increase risk of falls, poor quality transfers or incontinence prior to voluntary bladder emptying.
Cognition
- Is there any evidence of cognitive impairment?
- What is the person's ability to remember routines and timing of tasks? Have alternative methods been trialled to help with reminders?
Psychological factors
- Is the person ready or able to undertake change related to their bladder management such as incidents or being independent with their cares?
Body Shape and flexibility
- Can the person see and reach the urethral meatus to pass a catheter? Limitations due to reduced flexibility of the spine from orthopaedic fixations or body shape can result in an inability to visualise the urethral meatus. Postural changes such as lordosis can change the position of the surface anatomy.
- Would a mirror assist with this task?
Environment
- Can the person independently access a toilet in the community, at home or work? This includes opening a door and circulation space in the toilet/bathroom.
- Are they able to maintain a clean area/space/environment to perform intermittent catheters?
- Would modifications be helpful?
Wheelchair
- What is the set-up of the wheelchair? This includes footplates, balance of the wheelchair when doing a catheter or the option to connect an assisted drainage system.
Care Support
- Does the person require care support to assist with the bladder management and are there sufficient hours to accommodate this?
Gender
- Urethral access is more difficult for females.
- External condom drainage can only be used for males.
Intimacy
- The individual's goals regarding intimacy and sexual activity inform the choice of bladder management.
Comorbidities
- Does the person have any medical conditions or take medication that may impact on renal function (eg. OSA, diabetes mellitus, diuretic use)?
- Does the person have prostatomegaly that may cause lower urinary tract symptoms or result in difficulty inserting urethral catheters?
- Has the person had previous surgical interventions that might impact on their kidney or bladder function (eg. nephrectomy, Trans-Uretheral Resection of the Prostate (TURP))?