Method of bladder management

Trial of Void and Voiding

Considerations prior to Trial of Void (TOV)

Facilitators for commencing TOV

• Favourable signs for voiding are a rectal examination with normal sensation in S4/S5 dermatomes and the ability to voluntarily contact and relax the anal sphincter - Anorectal examination
• The presence of bladder sensation as well as a possible desire to urinate.

Potential barriers for commencing a TOV

• Suspected or confirmed Urinary Tract Infection (UTI) will delay commencing a TOV
• Consideration of Autonomic Dysreflexia risk. Provision of education on Autonomic Dysreflexia and management for those with a neurological level of T6 or above
• Screening for constipation. Constipation can increase frequency and cause bladder outlet obstruction.
• Assess functional skills such as mobility and independence with dressing skills
• Cognition or memory issues
• Medication review e.g., anticholinergics may impair the ability to void
• Relevant medical and surgical history eg. prostatic enlargement and pelvic floor issues

TOV Process

Bladder Scanning:

• It is important to measure the post void residual immediately after voiding for accuracy as the renal output can be 1-14ml per minute.
• Use ample gel on the probe and scan around two finger widths above the symphysis pubis, direct probe towards the bladder.
• Make sure the appropriate settings are selected

Be aware that:

• Trigger volumes: Some people may require a larger volume of urine to trigger a void. It is best to avoid over-distention of the bladder. The maximum volume of urine in a bladder should be 500ml. The bladder has also been on continuously draining with an indwelling catheter and may not be able to effectively hold large volumes of urine.
• Over-distension of the bladder may reduce blood flow to the bladder wall therefore making it more susceptible to infection from bacterial growth. Overstretching the bladder can also cause long term damage to the muscle and nerves.
• Ureteric reflux can occur with an upper motor neurone bladder. This can sometimes be a 'silent' issue.
• Deferring the trial of void or doing intermittent catheters won't delay recovery of bladder function. Intermittent catheterisation will help mimic normal bladder function with filling and emptying. This may also assist with planning for future attempts with TOV if there is an improvement with sensory feedback and control.