bladder retraining protocol

Indications

• to restore a normal pattern of voiding & continence after removal of an indwelling urinary catheter (foley)
• management of urinary urge incontinence

Management

urinary urge incontinence:

• frequent voluntary voiding
• retraining central & pelvic mechanism to inhibit detrusor contraction
• stand still or sit when experiencing the urge to void
• focus on making the urge diminish & pass
• taking a deep breath & exhaling slowly may be of benefit
• once in control of the urge, walk to the bathroom & void
• 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

• begin by taking the patient to the toilet
  • every 2 hours during the day & evening
  • QHS
  • every 4 hours at night
• instruct the patient on
  • techniques to trigger voiding
    • running water
    • stroking the inner thigh
    • suprapubic tapping
  • techniques to help empty the bladder completely
    • bending forward
    • suprapubic pressure
    • 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
  • urodynamic testing
  • 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:

• frequency, timing & amount of incontinence episodes
• fluid intake pattern
• 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:

• rule out reversible causes
• consider urodynamic testing

More general terms

• protocol

Additional terms

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