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bladder retraining protocol

Indications: 1) to restore a normal pattern of voiding & continence after removal of an indwelling urinary catheter (foley) 2) management of urinary urge incontinence Management: urinary urge incontinence: 1) frequent voluntary voiding 2) retraining central & pelvic mechanism to inhibit detrusor contraction 3) stand still or sit when experiencing the urge to void 4) focus on making the urge diminish & pass 5) taking a deep breath & exhaling slowly may be of benefit 6) once in control of the urge, walk to the bathroom & void 7) combine with Kegel exercises (women) remove indwelling catheter (not necessary to clamp catheter) after removal of an indwelling urinary catheter: - monitor the patient's urine output every 8 hours for 1-2 days initiate a toileting schedule 1) begin by taking the patient to the toilet a) every 2 hours during the day & evening b) QHS c) every 4 hours at night 2) instruct the patient on a) techniques to trigger voiding 1] running water 2] stroking the inner thigh 3] suprapubic tapping b) techniques to help empty the bladder completely 1] bending forward 2] suprapubic pressure 3] double voiding if the patient cannot void by the time the expected bladder volume is 800 mL (see Monitor ... above), or if the postvoid residual volume is > 400 mL, reinsert the catheter - consider a) urodynamic testing b) permanent catheter if the postvoid residual volume is 100-400 mL, continue to monitor until they are consistently < 200 mL record the resident's voiding & continence pattern with a bladder record that allows recording of: 1) frequency, timing & amount of incontinence episodes 2) fluid intake pattern 3) postvoid or intermittent catheter volume if the patient is voiding frequently (more frequent than every 2 hours), encourage the patient to delay voiding as long as possible encourage the patient to use pelvic muscle (Kegel) exercises & techniques to empty the bladder completely. if the patient continues to have episodes of incontinence: 1) rule out reversible causes 2) consider urodynamic testing

Related

indwelling urinary (foley) catheter pelvic muscle exercise (PMR); Kegel exercises urge incontinence urinary incontinence (UI) urodynamic testing

General

protocol

References

  1. Ouslander & Schnelle, Ann Intern Med 122:438, 1995
  2. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004