Bladder control training is a restorative rehabilitation measure for patients with upper motor neuron injury syndrome combined with bladder dysfunction.
Indications】
Patients with upper motor neuron injury syndrome combined with bladder control disorder, including spinal cord injury, stroke, traumatic brain injury, etc.. Patients with good hand function can do it independently, otherwise it can be performed by a chaperone. However, the patient must be able to cooperate actively.
[Contraindications
1, confusion, or inability to cooperate with treatment.
2.Severe infection of the bladder or urinary tract.
3.Severe prostate enlargement or tumor.
Instruments and equipment
No special instruments and equipment are required.
Operation procedure
1, bladder sphincter control training commonly used pelvic floor muscle exercises: active contraction of the pubococcygeal muscle (anal sphincter), each contraction lasts 10s, repeat 10 times, 3~5 times a day.
2, urinary reflex training to find or induce “trigger points”, through the reflex mechanism to trigger the contraction of the urinary avoidance muscle, in order to active urination. The common urination reflex “trigger points” are lightly buttoning the suprapubic area, pulling the pubic hair, rubbing the inner thighs and squeezing the **glans. Listening to the sound of running water, hot drinks, warm baths, etc. are all supplementary measures. It is advisable to tap lightly and quickly and avoid heavy tapping. Heavy tapping can cause vesicourethral dysfunction. The frequency of percussion is 50~100 times/min and the number of percussions is 100~500 times. Higher spinal cord injuries can generally restore reflex urination.
3, compensatory voiding method training to promote voiding through manipulation and increasing abdominal pressure, etc., mainly includes.
(1) Valsalva method: the patient takes a sitting position, relaxes the abdomen and tilts the body forward, holds the breath for 10~12s, transmits abdominal pressure to the bladder, rectum and pelvic floor with force, flexes the hip and knee joints, keeps the thighs close to the abdomen, prevents abdominal bulging and increases abdominal pressure.
(2) Crede maneuver: place both thumbs at the iliac crest and the remaining fingers on the top of the bladder (below the umbilicus) and gradually apply pressure inward and downward, or use your fist to roll from deep pressure at the umbilicus toward the pubic bone. Pressure must be applied slowly and gently, avoiding violence and direct pressure on the pubic bone. Excessive bladder pressure can lead to bladder injury and urine reflux to the kidneys.
4, water intake and output control training to establish a system of regular, quantitative drinking and regular urination. This is the basic measure of various bladder training. Since the physiological capacity of the bladder is thought to be about 400ml, it is appropriate to drink 400~450ml of water each time to make the bladder capacity reach about 400ml when urinating afterwards. The time interval between drinking and urination is generally 1~2h, which is related to body position and temperature. The interval between urination is shortened when lying down and the temperature is low, and lengthened vice versa. A total daily urine volume of 800~1000ml is appropriate.
5. Clean catheterization (intermittent catheterization) Clean catheterization is the initial step to end retained catheterization so that the above bladder training can be carried out effectively. Also, when the bladder cannot be emptied sufficiently by the above methods, clean catheterization can be used to intermittently empty the residual urine to reduce the chance of bladder infection. See “Clean catheterization technique” for details.
Precautions
1.Monitoring of bladder residual urine volume must be strengthened at the beginning of training to avoid urinary retention.
2. Avoid urine reflux to the kidney due to overfilling of the bladder or excessive pressure by manipulation.
3.The bladder reflex needs some time to accumulate, so pay attention to gradual progress when training.
4.When combined with spasticity, bladder emptying activity is closely related to the onset of spasticity, and attention needs to be paid to the relationship between urination and release of muscle spasm.