Stroke patients present with urinary frequency, urgency, and other urinary abnormalities. For the rehabilitation of their functions, bladder training, bladder stimulation, Valsava maneuver, Crede maneuver and psychological guidance can be used to restore their normal functions.
1.Bladder training The bladder training method can increase the bladder capacity and lengthen the interval of urination. The daily urination situation can be improved continuously.
(1) Suprapubic tapping method Commonly used in patients with upper motor neuron vesicourethral dysfunction (nerve injury or lesion above the sacral medulla) with hyperreflexia of the detrusor muscle. The contraction of the detrusor muscle is induced by the response of the detrusor muscle to the pull reflex via the sacral medullary detrusor center. The patient can produce urination by tapping the suprapubic area with a finger to cause contraction of the detrusor muscle without simultaneous contraction of the urethral sphincter.
(2) Breath-holding method A method of increasing abdominal force to raise bladder pressure and open the bladder neck to induce voiding. The patient leans forward, takes 3-4 quick breaths to prolong the breath-holding period and increase the abdominal pressure, takes a deep inhalation, then holds the breath and makes a downward forceful defecation movement. Repeat this intermittently several times until no urine is discharged.
(3) Squeeze method Suitable for patients with forced urinary muscle weakness. First, use the fingertips to massage the bladder deeply, which can increase the bladder tension. Then make the fingers into a fist and place them 3 cm below the umbilicus, apply pressure to the sacrococcygeal area with force, lean the patient’s body forward and change the direction of pressure until the urine flow stops.
2.Bladder stimulation The method is as follows: forceful deep pressure on the lower abdomen, the force acts on the bladder wall, mostly to obtain a urinary response, or patting or squeezing the skin of the perineum.
3.Valsava maneuver The patient is in supine position with the trunk bent forward and the hip bent with the hands on the knees, this method increases the intra-abdominal pressure and helps urination.
4.Crede’s technique The thumbs of both hands are placed on the anterior superior iliac spine, and the other four fingers are placed on the abdomen above and below the pubic bone.
5.Psychological guidance should be carried out throughout the rehabilitation process, and the stroke patient and his family should do a good job of explaining the ideological work, eliminating psychological concerns and establishing confidence in urination.