Question

A female client with chronic urinary retention explains double voiding technique to the nurse by stating she voids partially, hold the remaining urine in her bladder for three minutes, then voids again to empty her bladder fully. How should the nurse respond?

Answer 1

The nurse should confirm the double voiding technique's effectiveness for the client's chronic urinary retention but recommend consultation with a healthcare provider to ensure it's appropriate and rule out other issues. Double voiding helps to more effectively empty the bladder, which can be beneficial as the strength of bladder muscles diminish with age or in certain medical conditions.

Step-by-step explanation:

The technique of double voiding, as described by the client, is a strategy used to more completely empty the bladder in cases of chronic urinary retention. It's important to note that the micturition reflex, which is what triggers the sensation to urinate and leads to the contraction of the bladder via the detrusor muscle, can become less effective over time, especially in the elderly or those with certain neurological conditions. In the context of a full bladder, the reflex becomes even more significant as involuntary actions of the internal urethral sphincter and voluntary actions of the external urethral sphincter come into play.

When the client opts to void partially, then waits for a short period before voiding again, it allows the bladder muscles to contract twice and can lead to a more effective emptying of the bladder – this is especially useful as the bladder's strength decreases with age. The nurse should affirm the technique if it has been effective for the client but should also suggest that the client discuss ongoing symptoms of urinary retention with their healthcare provider to rule out any other underlying conditions and to ensure this is the most appropriate management technique for them.

Generally, adults should be able to control when they urinate until the bladder fills to a certain point (about 300 to 400 mL). However, in individuals with chronic conditions or impaired bladder function, normal urination patterns can be altered, making techniques like double voiding necessary to prevent urinary tract infections and other complications related to incomplete bladder emptying.