8.6: Treatment of Voiding Disorders (Excluding Voiding Difficulty After Incontinence Surgery)
- Page ID
- 15617
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The treatment of voiding disorders obviously is dependant on the underlying cause. If the underlying cause is obstructive, such as in pelvic swellings, uterovaginal prolapse, constipation or foreign bodies, these problems should obviously be attended to.Treatment of vulvo-vaginitis and urethritis goes without saying. In consultation with the medical practitioners taking care of this particular patient, changes in medication, which might be causing the problem should be considered as well as attention to the psychological and psychiatric health of the individual.
If the condition is untreatable or chronic, such as in neurological disorders, the following options are recommended:
- Timed voiding with assistance in increasing abdominal pressure, such as the Valsalva manoeuvre or Crede’s manoeuvre, where the patient or an assistant increases the abdominal pressure by pushing suprapubically.
- Intermittent clean catheterisation. This has proven to be a very useful and safe method of emptying the bladder without continuous catheterisation. This can be done at 2-4 hourly intervals and can be performed by the patient themselves if they have the necessary motor co-ordination to do it. In spinal injuries below C7, most patients can manage this themselves. Clean catheterisation as opposed to sterile catheterisation is quite acceptable in the home environment, however in hospital, it might be more appropriate to use sterile techniques to prevent cross infection.
- Continuous catheterisation. This can either be done by trans-urethral catheter or supra-pubic catheterisation. These patients need careful surveillance for urinary tract infection, stone formation and regular cystoscopy to exclude the development of bladder carcinomas.
- Medical therapy. Medical therapy should be aimed at treating urinary tract infections and reducing the risks of high pressure bladders with a closed urethra by using anti cholinergic agents. Medical therapy to increase detrusor contractions has been disappointing.
- Neuromodulation with stimulators might be used in some of these conditions.