Manual Provocation of Micturition Contraction in Neurogenic Bladders

Abstract

The ability of the following trigger procedures to induce a micturition contraction in neurogenic bladders has been compared by electromanometric cystometry: plantar stimulation, deep breaths, coughing, straining, cutaneous stimulation of abdomen or thigh, peri- and intraanal stimulation, and suprapubic rhythmic manual pressure. The material included 13 patients with reflex bladders, 9 with autonomous bladders, and 10 normal controls. Suprapubic rhythmic manual pressure was found to be the most effective method and elicited response in all reflex bladders, but did not induce a micturition contraction in either autonomous or normal bladders. Detailed studies of this trigger procedure showed that contraction of the abdominal wall hinders response to the manual pressures, the optimum effect of which is obtained by hitting directly down onto the bladder wall with quick, locally deforming blows or pushes of some force, repeated at a rate of 7-8 per 5 secs. A number of important features in the practical application are described. Experiments confirm the impression that the stretch effect on the bladder wall is the crucial part of the mode of action, which is assumed to be an activation of the sacral spinal reflex arc for micturition contraction by artificial induction of the normal micturition stimulus, mediated by tension receptors in the bladder wall. The response is not the result of so-called “bladder training” or “conditioning of reflexes”. Many years of clinical experience have confirmed the validity of the results reported here. The reaction seems so reliable that cystometric demonstration of a micturition contraction in response to suprapubic rhythmic manual pressure administered according to the technique described here may be accepted as a diagnostic criterion for neurogenic bladder of the reflex type (automatic bladder or uninhibited neurogenic bladder).