Other Conservative Bladder Methods

Tapping and Expressing

Tapping and expressing was used for management of upper motor neurone (UMN) bladders and may have been used in combination with a sphincterotomy, particularly in male patients. This method is no longer commonly used. The method involved tapping over the pubic area to stimulate spasticity and activity with the detrusor to promote emptying of the bladder. Expressing the bladder is initiated by applying pressure over the pubic area to assist with drainage once a stream was initiated. This method needs to be attended a few times during the day to allow complete emptying of the bladder although this is more difficult to do in a wheelchair.

An external drainage device (urinary sheath) is used and therefore, it can only be used with males.

Other issues with this management are related to skin irritation from sheath usage and issues with application due to reduced penile length.

Valsalva or Credé manoeuver (Straining)

Valsalva or Credé manoeuver 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) with 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.