The Credé maneuver is a simple, non-invasive technique involving the application of manual pressure to the lower abdomen with the goal of assisting in bladder emptying. This procedure is a facilitatory voiding method intended to manage urinary retention, a condition where a person cannot fully empty their bladder. The technique is named after 19th-century German obstetrician Carl Credé. By manually pressing on the area directly above the pubic bone, the maneuver works to increase pressure within the bladder, which helps to force urine out through the urethra.
When the Maneuver is Necessary
The Credé maneuver is considered for individuals experiencing urinary retention due to a flaccid or poorly contractile bladder. This condition often arises from nerve damage that prevents the bladder’s detrusor muscle from squeezing effectively to expel urine. Common patient populations who might use this technique include those with specific types of neurogenic bladder, such as from a spinal cord injury or spina bifida.
People with severe diabetic neuropathy can also develop a loss of bladder sensation and poor muscle function, making the maneuver a potential aid for voiding. The technique is useful when the bladder muscle is weak, but the external urethral sphincter is able to relax sufficiently to allow urine flow. The primary goal is to prevent the complications of residual urine, such as bladder stones, chronic bladder distension, and urinary tract infections.
Performing the Credé Maneuver
The procedure begins with proper positioning, which is typically a sitting position, such as on a toilet or bedside commode, or an upright Fowler’s position for bedridden patients. The patient should be relaxed and ready to attempt urination before the pressure is applied. The individual performing the maneuver, who may be the patient themselves or a caregiver, first locates the bladder just above the pubic bone and below the navel.
The first step often involves a downward stroking motion, using the hands to apply gentle, firm pressure from the navel down toward the pubic bone. This initial stroking is intended to help stimulate the voiding reflex. Following this, direct pressure is applied over the bladder itself, just above the pubic arch.
The most effective method involves placing one hand on top of the other and pressing firmly inward and downward toward the pelvis. This sustained pressure is held until the flow of urine stops completely. The pressure effectively compresses the bladder, mechanically forcing the retained urine out of the body.
Potential Complications and When to Avoid It
While the Credé maneuver is non-invasive, it is not without risks, particularly with improper or long-term use. One of the most significant complications is the potential for increased bladder pressure, which can force urine backward up the ureters towards the kidneys, a condition known as vesicoureteral reflux (VUR). This backflow can increase the risk of kidney infections and, over time, lead to hydronephrosis, or swelling of the kidneys.
The maneuver should be avoided in patients who have a known risk of urine backflow or in children with neurogenic bladder, as this population has an increased risk of severe kidney damage, including renal rupture. The forceful application of pressure can also lead to other complications, such as abdominal bruising, the formation of a hernia, or exacerbation of hemorrhoids.
The technique is contraindicated immediately following any abdominal or pelvic surgery, as the pressure can tear stitches, cause bleeding, and delay healing. Patients with untreated urinary tract infections, bladder stones, or a suspected overactive urethral sphincter mechanism should also avoid this maneuver. In many cases, clean intermittent catheterization is considered a safer and more effective alternative for long-term bladder management.