Crede maneuver is a urine voiding facilitatory technique that involves applying manual pressure on the lower abdomen. It’s usually accomplished in two successive steps.
Essentially, exerting pressure through the abdominal wall increases the pressure in the bladder while relaxing the external urethral sphincter, allowing the urine to flow out through the urethra. This can be done when a person is sitting on a toilet seat/bedside commode, standing (male patients), or in a fowler’s (sitting) position in the case of an invalid.
However, you should exercise caution when performing the procedure as excessive pressure can injure internal organs. Also, in cases where the maneuver is performed wrongly, it can lead to urine backflow from the bladder up the ureters, a condition known as vesicoureteral reflux.
This procedure also increases the risk of complications under some conditions. For instance, a girl with a neurogenic bladder had a renal rupture after a crede maneuver.
For these reasons, the technique should be administered or supervised by someone who has undertaken a crede maneuver lesson. Patients can also perform the procedure on themselves after they have appropriate instructions.
Start Our Genitourinary Course FreeCrede maneuver is one of many voiding facilitatory maneuvers (Valsalva, crede, suprapubic, etc.) It’s named after Carl Crede, a German physician (gynecologist and obstetrician).
Crede developed the method initially to help expel the placenta from the uterus after vaginal delivery. Crede maneuver was later adopted to aid in removing urine through a flaccid bladder.
Though it’s an inexpensive and non-invasive procedure, its efficacy at emptying the bladder is wanting. A urodynamic study that evaluated 207 patients suffering from various lower urinary tract disorders confirmed that the method could not be relied on to void the bladder completely.
Another study evaluating the reliability of crede maneuver in patients with urine retention reached a similar conclusion. In the study, patients who had undergone haemorrhoidectomy (a surgery for removing hemorrhoids or piles) were placed in two groups.
One group was taught crede maneuver, while the other was trained on traditional voiding methods. Though the non-crede group had a bladder emptying rate of 30%, the crede group’s rate was at 91%, indicating the inefficacy of the method to clear the bladder completely.
Crede maneuver is generally used on patients with the issue of urinary retention (UR). UR is caused by several factors, including neurogenic bladder, urinary tract infections, and prostate enlargement.
Neurogenic bladder refers to an inability to control the bladder due to brain, nerves, or spinal cord problems.
Typically, when the bladder fills, the brain sends messages to the bladder muscles to hold the urine, then relax to release it when you are ready. When any of the coordinating organs are not functioning well due to illness or injury, bladder control is lost alongside.
The condition affects millions of people, including people with issues such as spinal cord injury, nerve damage, congenital disabilities, etc.
Note that spinal cord injury does not always cause loss of bladder control. Some patients still have feelings and can be able to control urination.
Overactive bladder involves sending signals at the wrong time. This often leads to issues such as high urination frequency, sudden urge to urinate, or urine leakage (incontinence).
Likewise, the nerves may fail to send signals, leading to the inability to urinate despite a full bladder (urinary retention).
Urinary tract infection (UTI) refers to an infection on any part of the urinary system – kidneys, bladder, ureters, urethra. Types of UTI vary depending on the part of the urinary tract affected – acute pyelonephritis (kidney), cystitis (bladder), urethritis (urethra).
The prevalence of UTI is higher in women than men due to their makeup. Generally, UTI causes several issues, including urinary retention, cloudy urine, strong-smelling urine, burning sensation during urination, pelvic pain (in women), etc.
If left untreated, the condition often causes complications such as recurrent infections, increased risk in pregnant women, sepsis, permanent kidney damage, urethral narrowing, etc.
Benign prostate enlargement is a medical term for enlarged prostate. The prostate is a gland in the male reproductive system which surrounds the urethra.
When the gland enlarges – benign prostatic hyperplasia (BPH) – it compresses the urethra preventing the free-flowing of urine from the bladder. The risk of developing BPH increases with age, with the rate hitting over 90% in men aged above 80.
Symptoms of BPH include urinary retention, dribbling after urination, and incontinence.
Urinary retention (UR) refers to an inability to empty the bladder. The condition can be chronic or acute.
Chronic urinary retention (CUR) is long-term. People suffering from the condition can pass urine, but the bladder does not empty fully.
On the other hand, acute urinary retention (AUR) is sudden and involves the inability to pass any urine, which makes it potentially life-threatening.
CUR develops gradually, meaning it can go undetected at the earliest stages. However, AUR is often accompanied by excruciating pain requiring immediate medical attention.
Generally, UR manifests differently depending on the type. Though initially hard to detect, chronic urinary retention symptoms include;
Acute urinary retention symptoms include;
Though the prevalence for UR is higher in older men, with the rate of AUR going up to 1 in 3 men aged 80 and above, both women and men of all ages can have urinary retention. UR can be caused by several factors, including urethra blockage, medications, nerve problems, etc.
Blockage causes the urethra to narrow, making it difficult for urine to pass through. This can be caused by issues such as;
Inefficient bladder contraction is a problem characterized by loss of bladder muscle strength. As a result, the muscles fail to contract with enough strength and long enough to void the bladder.
Various factors can cause the issue, including;
Note: Some types of surgery, such as hip replacement, rectal surgery, pelvic surgery, etc., can cause trauma, tissue scarring, or swelling, thereby interfering with the functioning of the bladder and urethra.
Emptying the bladder, whether using crede maneuver or other methods such as urethral catheterization, is essential as prolonged urine retention can lead to severe complications. Some possible dangers of urinary retention include;
The urine can also travel back to the kidney from the bladder. Eventually, conditions such as kidney disease and kidney failure may develop.
Crede maneuver requires minimal equipment, unlike many other UR interventions. To perform the procedure on a patient, you only need;
Crede maneuver is a simple procedure once you learn how to perform it properly. Below are the steps involved;
Essentially, the crede maneuver should not be used as a primary method of bladder voiding but should complement other interventions such as self-catheterization or pending a medical procedure. Emptying the bladder using crede maneuver over a long time is not safe.
Possible complications include:
There are medical situations that may render the crede maneuver inappropriate. These include issues such as;
As earlier indicated, the crede maneuver is not efficient in emptying the bladder completely. However, it’s a handy procedure that can be used as a temporal measure before procedures with a high efficacy rate are applied.
Alternatives of Crede Maneuver include;
Valsalva maneuver – This involves straining the abdominal muscles. To perform a Valsalva maneuver, you sit on the toilet and push down the way you do during a bowel movement. For added pressure, you can compress your lower abdomen with your forearm.
Suprapubic tapping – This involves tapping the area between your navel and pubic bone rhythmically to stimulate the voiding reflex. Essentially, you should tap the suprapubic region repeatedly for 30 seconds at one tap per second.
This should trigger the nerves and cause the external urethra sphincter to relax and let out urine.
Catheterization – In case of acute urine retention, immediate urine removal is necessary, which can be done using a catheter. However, catheterization can also be used for CUR cases.
This involves inserting a catheter inside the urethra to remove the urine, which can either be indwelling or intermittent.
With indwelling catheterization, the catheter is left in the bladder, while intermittent involves inserting on a need basis then removed after urination. Intermittent catheterization can be done at the hospital, or the patient can be taught how to do it independently at home.
Medication – Once the cause of the urinary retention has been established, an appropriate remedy can be administered to cure the problem. Medicine may include;
Medical procedures
Surgery – If the above interventions fail to resolve urine retention, surgery can be done as a last resort. This may include;
Bladder training – Urination is a natural process that involves the contraction of the bladder muscles and relaxation of the sphincter muscles to let the urine out. When a person is anxious, the sphincter muscles may fail to relax, causing the holding back of urine.
Practicing relaxation techniques has been known to help some patients overcome the challenge of urinary retention. Relaxing allows the body to function normally, which helps the sphincter muscles open up the urethra for the urine to flow freely.
Therapy – Involves performing Kegel exercises (pelvic floor muscles exercises) to train the muscles to function optimally, enabling you to regain control over the pelvic area. Usually, the patient tightens and relaxes the pelvic muscles repeatedly, e.g., holding them tight for 5 seconds, then relaxing them for another 5 seconds and repeating the procedure about ten times, three times per day.
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Resources:
https://pubmed.ncbi.nlm.nih.gov/6887405/
https://nursekey.com/credes-maneuver/
https://www.urologysanantonio.com/urinary-retention
https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention/symptoms-causes
https://my.clevelandclinic.org/health/diseases/15427-urinary-retention
https://www.aafp.org/afp/2018/1015/p496.html#sec-3
https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention/definition-facts
https://lluh.org/conditions/urinary-retention