Which action is most important during bladder training in a patient with a neurogenic bladder?
A. Encourage the use of an indwelling urinary catheter.
B. Set up specific times to empty the bladder.
C. Encourage Kegel exercises.
D. Force fluids.
Correct Answer: B. Set up specific times to empty the bladder.
Instruct the patient with a neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day. Offer an opportunity to void every 1 to 2 hours, even if the urge to void is not felt. Intervals may be based on a shorter time than exist in continent voiding.
Option A: Initiate voiding by manual stimulation, i.e., apply pressure with hands over the suprapubic area or bend the patient over to increase intra-abdominal pressure. During the program, the bed and clothing may be padded to protect them from becoming wet, avoid diapering, since this further demeans the person and may give “permission” to be incontinent.
Option C: Instruct patient to do vaginal and rectal contractions to strengthen periurethral tissue (Kegel exercises). Perform these exercises 10 times daily over a 6 to 8 week period. Evaluation of the exercise program is then done.
Option D: Record time and amount of fluid intake. If no fluid restriction, encourage daily intake of 2000-2500 mL per day. Limit in the evening. Repeat voiding by manual compression every 2 hours to prevent over-distention.
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