8 replies to this topic

[A trophy guy]

This is something that has been in the back of my head for some years now. I have always considered myself very lucky when it comes to bladder and voiding issues, as I can empty my bladder successfully without catheterization by both the crede and valsalva methods.

I can feel when I have to pee, and I can control it, so what I use is sort of a hybrid system of crede/valsalva; depending on the time of day. Crede is much easier and less strenuous of the two methods, but I can only mostly empty my bladder with it alone.

Now for the most part, mostly emptying my bladder is sufficient and allows me to solely use the quicker, more convenient crede method when I have to pee. However, on two occassions during the day I do empty my bladder more completely and to do this I must use a combination of the two methods. These times are when I first get up in the morning (I want to get all the old urine out of my system) and right before I go to bed (I want to be able to sleep as long as possible undisturbed). Plus I know it's necessary to totally (mostly) empty the bladder to avoid problems.

To do this, I do my regular crede pressing on my bladder. When this empties the amount that it is capable of, I then revert to the valsalva technique and squeeze my abs (hard) to get the last bit out. I could do this technique for the entire emptying, but it is tiring and I believe overly strenuous (plus time-consuming). So I combine the two for a perfect fit.

But, just like many other aspects of life in wheelchair, the ways in which I am using my body now to empty my bladder are not the ways in which my body was naturally designed. So I am worried that sooner or later something bad will happen due to the things I am doing to my body, time after time, day after day, to pee.

The crede method is more worrisome to me that the valsalva, for one because I use it much more but also because it feels so much more intrusive and unnatural than the other. But valsalva has it's own concerns too. That kind of straining, over and over for years, seems risky for a number of reasons. Blood pressure reasons, stroke risks, hemorrhoids and that's just off the top of my head.

Now neither of these cause me any pain. But I wonder if there is any info or knowledge about others suffering damage or injury from long-term use of such techniques for bladder management. And by long term use I mean at least several years.

And I know there are those who have gone 20, 30, 40 years using these techniques without a single issue. While that's great, that's not what I want to know. I know such success can happen. I just want to know if the flip-side to that success happens with any sort of regularity. Or if I am being more paranoid than I should be. After all, I've had no problems at all up to this point.

[nomis]

Yeah, the jury is still out on this one. Not enough long-timers have gone ahead of you to make a worthwhile study. Maybe that day is coming soon if someone thinks to do the study.

The spearhead of reasonably reliable statistical evidence for the long-term SCI are the American servicemen injured in the Vietnam War. That information is only now coming to light.

Your experience might become part of that pioneering research.

[Apparelyzed]

Hi,

Both methods increase internal bladder pressures, and there is little information on long term users on such methods.

I did find the following which may be of interest however.

9. Clinical Outcomes

The prevalence of urologic complications is high among the population having practiced Crede maneuver for more than 20 years to expel urine. Urinary lithiasis in 31.3%, hydronephrosis in 35.1% and renal damage in 16.2%. [Chang 2000]
Men are more susceptible to upper urinary tract deterioration than women. [Chang 2000]

10. Advantages

Relatively easy procedures for the patients to perform
Do not require any additional device

11. Disadvantages

Chances of complications:
More than 40% of patients showed demonstrable influx into the prostate and the seminal vesicles and other complications, e.g. epididymo-orchitis. [Madersbacher 1977]
The high pressures cause reflux into the upper urinary tract with all known complications [Madersbacher 1977]
Preexisting VUR is a relative contraindication, especially in patients capable of generating a high intravesical pressure by these maneuvers.
If adequate emptying does not take place, other modes of management to decrease outlet resistance should be considered (for example, external sphincterotomy). However, these may cause undesirable urinary continence.

Source

If you use these methods for long term bladder management, then close follow-up and urodynamic evaluations are necessary to avoid complications.

Simon.

[ClaraTaylor]

Apparelyzed, on 01 December 2011 - 11:37 AM, said:

If you use these methods for long term bladder management, then close follow-up and urodynamic evaluations are necessary to avoid complications.

Simon.

I've been using these methods for just under 7 years. Who should I be seeing for evaluations and such like? (Currently only under the care of my GP).

[Apparelyzed]

Well, if you've been to a spinal injury centre, then I'd contact outpatients and see what they recommend. Otherwise, address your concerns to your G.P with a view to getting a referal to either a spinal centre or urologist.

It probably also depends on how much pressure you need to apply before voiding is induced.

Simon

[Tetracyclone]

My doctor recommended a yearly urodynamic exam.

I commonly use the crede method, pressing on certain points in the bladder region with my thumbs. I also IC, but in between i do a lot of poking and pressing.

During the night i get pretty goofy, often swaying on the port-a-pot next to the bed. So far I have not fallen off, but i don't know why. Needless to say, my poking is often done in my dreams- I mean, I might have been done 10 minutes ago but I'm still dreaming that urine is coming out. Remember, I am nearly deaf, so I cannot hear my urine, and sensation? maybe I feel something, maybe I dont. it is difficult to be sure.

I knew I was in trouble when I woke up one morning to find a big purple bruise across the lower abdomen. Big trouble.

[paraguy1]

I have been using the valsalva technique for 5 years now and have been wondering the same thing. I didnt know it caused hemmorhoids. Plus I only have one kidney so I really have to be careful. I lost a kidney awhile back after my accident they found I had a bad one that I was born with. That was worse than my back surgery.

Edited by paraguy1, 01 December 2011 - 03:18 PM.

[Scorpio81]

I did the crede technique (before I even knew that's what it was called!) for over 10 years before starting ISC - I think I did a form of valsalva too, mainly straining to squeeze the urine out, but I found this quite physically draining. The renal ultrasound I had 2 years ago showed that there was dilatation of the collecting systems within my kidneys. They said it was probably caused by the residual urine (as I was retaining around 300ml) and high pressures reached due to the bladder spasms, but now you've mentioned this, I wonder whether all the pushing and straining contributed to it? I've also wondered whether it's had any effect on my pelvic floor muscle. I know it's weak because of my nerve damage, but maybe all the straining weakened it further? I don't have any pelvic organ prolapses at the moment, but I guess time will tell.

Anyway, that's just my take on it - it's an interesting subject nonetheless.

[A trophy guy]

Thank you, Simon, for that info.