The Credé maneuver is a technique for bladder expression that involves applying manual pressure to the lower abdomen to help release urine. Named after the 19th-century German obstetrician Carl Credé, the maneuver was adapted for use in patients experiencing urinary retention. This method of external pressure is one of the oldest techniques used to facilitate urination.
The Mechanism of Bladder Expression
The Credé maneuver uses external force to empty a bladder that cannot contract on its own. It is applied to patients with a flaccid or areflexic bladder, often resulting from a spinal cord injury or other neurological condition that impairs the normal voiding reflex. These conditions prevent the detrusor muscle, the smooth muscle layer of the bladder wall, from squeezing to expel urine.
Applying pressure to the lower abdomen physically compresses the bladder, significantly increasing the pressure inside the organ, known as intravesical pressure. This manual compression forces the urine out past the urethral resistance, simulating a healthy detrusor muscle contraction. The technique is a mechanical solution to overcome the loss of voluntary or reflexive muscle control necessary for proper urination.
Detailed Steps and Technique
The maneuver begins with proper patient positioning, typically sitting upright in a Fowler’s position, semi-reclined, or standing. The person performing the maneuver places their hands flat over the lower abdomen in the suprapubic area, just above the pubic bone. This location allows for manual compression of the full bladder above the pelvic bone.
The pressure is applied downward and inward, toward the pelvis. This motion compresses the bladder and directs the flow of urine toward the urethra. The force must be firm enough to expel the urine but gentle enough to avoid causing internal injury or pain. The pressure is sustained or repeated until the flow of urine stops, ensuring the bladder is emptied completely.
Risks and Modern Clinical Status
The Credé maneuver carries a high risk of complications, primarily due to the excessive intravesical pressure it generates. This high pressure can force urine backward up the ureters toward the kidneys, a condition known as vesicoureteral reflux. Reflux exposes the upper urinary tract to bacteria, significantly increasing the risk of recurrent urinary tract infections (UTIs) and potential kidney damage, including hydronephrosis.
For individuals with a spinal cord injury at or above the T6 level, the high intravesical pressure can trigger autonomic dysreflexia. This condition involves a sudden, severe spike in blood pressure in response to an irritating stimulus below the level of injury. Furthermore, overly aggressive or incorrect application of the maneuver may cause bruising, bladder wall damage, or, in rare instances, renal rupture.
Due to these risks, the Credé maneuver is largely discouraged or considered obsolete in modern urological practice for long-term bladder management. Safer and more effective alternatives, such as clean intermittent catheterization (CIC), are the preferred methods for patients who cannot empty their bladders naturally. A modified form of external bladder compression may still be used in specific, monitored clinical situations, such as during some surgical procedures.