In a hospital setting, patients are often restricted to a supine position due to surgical recovery or medical directives. This lack of mobility can make basic functions, such as urination, a source of discomfort and anxiety. Voiding while lying down is a common necessity that requires specific preparation and technique. This guide offers practical instructions for managing this situation effectively.
Essential Equipment and Proper Positioning
The primary tools for voiding while lying down are the bedpan and the male urinal. The standard bedpan is typically oval-shaped, requiring the patient to lift their hips significantly for placement. For patients with hip fractures or limited strength, a fracture bedpan is often used instead. This type features a flatter, tapered edge designed to slide more easily beneath a patient who can only tilt their pelvis slightly, minimizing movement and reducing pain.
Male patients are typically provided with a handheld plastic urinal, a jug-like container that requires careful placement but no major body movement. Preparation begins by ensuring patient privacy, which involves closing the door and pulling the bedside curtains closed. The hospital bed should also be raised to a comfortable working height for the assisting staff member, facilitating safe positioning of the device.
To place a standard bedpan, the patient is usually asked to bend their knees and push up while a nurse assists in sliding the pan underneath. If the patient cannot lift, the nurse will assist by gently rolling the patient onto one side. The pan is placed against the hip, and the patient is rolled back onto the pan, centering the buttocks over the collection area. For the male urinal, the patient or nurse positions the opening securely against the penis to direct all urine into the container.
Techniques for Successful Voiding While Supine
Once the equipment is correctly positioned, the patient often faces a psychological barrier, as the body is conditioned to void in an upright or seated position. Maintaining privacy is paramount, as the feeling of exposure can trigger a reflex known as paruresis, inhibiting the sphincter muscles. Requesting that staff leave the room, if safe, can significantly reduce anxiety and promote successful voiding.
Initiating the stream requires conscious relaxation of the pelvic floor and external urethral sphincter, which is harder when lying flat. Deep, slow abdominal breathing can signal to the parasympathetic nervous system that the body is safe and relaxed. Focus on exhaling slowly and allowing the lower abdominal muscles to soften, which directly aids in relaxing the muscles.
Many people find success by employing sensory cues or visualization techniques to override the mental block. Visualizing a flowing stream of water or listening to the sound of running water can stimulate the micturition reflex. The brain associates these cues with the act of voiding, making it easier to trigger the physiological process while supine.
Unlike voiding while standing, gravity does not assist the process, requiring the bladder muscles (detrusor) to work harder. The patient must be patient, as the urge to void may feel different or take longer to manifest. Focus on a sustained, gentle push from the abdominal muscles rather than straining, which can cause the pelvic floor to tighten instead of relax.
Addressing Common Difficulties and When to Seek Assistance
Despite using relaxation techniques, common difficulties such as performance anxiety and embarrassment can still prevent successful voiding. The body’s normal reflexes are disrupted when lying down, and the conscious need to urinate on demand can compound the problem. A simple coping mechanism is to focus intensely on a distraction, such as counting backwards from 100, instead of concentrating on the act of urination.
A medical concern arises when the patient experiences urinary retention, the inability to completely empty the bladder. Symptoms include a persistent feeling of fullness or pressure in the lower abdomen, discomfort, and a strong, unfulfilled urge to void. Prolonged retention can lead to bladder distention and potentially harm the kidneys, making timely action necessary.
If a patient has not successfully passed urine after several attempts, or if six to eight hours have passed since the last successful void, the nursing staff must be alerted immediately. This time frame is a general guideline used to monitor for retention, especially following surgery or certain medications. Medical intervention may be required to empty the bladder safely.