Bladder care and management

Bladder health and emptying

You have been given this information leaflet as you may be having some difficulties emptying your bladder fully. Its aim is to explain how your bladder normally empties, what causes reduced bladder emptying and what can be done to help. Reduced bladder emptying can occur gradually over a period of time or rapidly. It can also be a temporary or permanent problem depending on the cause. There are simple ways in which you can improve and aid bladder emptying.

Urinary bladder function

The urinary bladder is a hollow, muscular organ in the body that collects and stores urine after it passes through the kidney. The main function of the bladder is to store urine and to assist in emptying. The bladder has to store enough urine to allow you to undertake daily activities and sleep at night. Maximum capacity of the bladder is usually about 300 to 600ml. We usually empty when the bladder is about two-thirds full.

For the bladder to empty fully, you need an intact nerve control system between your brain and the bladder. This tells your body when you need to pass urine and stores the urine until you are on the toilet.

It is important that you are in a comfortable position and ready to empty your bladder. The bladder sphincter muscle and pelvic floor muscles relax and the bladder simultaneously contracts and starts to empty itself of urine. This process allows the urine to flow and the bladder to empty. It is not normal to strain to empty your bladder.

What can cause your bladder to not empty properly?

It may be due to one or a combination of the following reasons, either medical or non-medical.

Non-medical reasons

• Women ‘hovering’ rather than sitting over the toilet.
• Being in a rush and not allowing enough time to empty your bladder.
• Reduced privacy, for example public toilets or sitting on a commode behind curtains.
• Going too often and passing small amounts of urine, which reduces the bladder muscle pressure and flow rate.

Medical reasons

• Constipation – a full bowel obstructs the passage of urine.
• Enlarged prostate gland in men can obstruct normal flow.
• Vaginal prolapse.
• Nerve damage to the bladder, spinal cord or brain, for example accidental injury, multiple sclerosis, stroke, Parkinson’s disease, diabetes and dementia.
• The bladder muscle having been over-stretched previously (after a period of short- or long-term urinary retention).
• After any surgery.
• Certain medication.
• After childbirth.
• After Botox® injections for an overactive bladder.

The importance of bladder emptying

Emptying your bladder fully every three to four hours will reduce the likelihood of developing urinary tract infections, cystitis and will protect your kidneys from damage. If your bladder fails to empty and goes into retention, the bladder muscle can become overstretched and can be damaged. An overstretched bladder struggles to contract and empty the bladder effectively.

When the bladder is not functioning properly, it may cause complications like urinary tract infection and kidney stones, or it could be connected to bowel dysfunction. Bowel and bladder health go together. It is very important to regulate bowel movement as it could also help to maintain bladder function.

How will you know you are not emptying your bladder?

The symptoms may include one or more of the following:

• inability to pass urine
• increased frequency – feeling that you want to go shortly after passing urine
• passing small amounts of urine
• urinary incontinence – involuntary loss of urine
• poor urinary flow rate, hesitancy or straining to pass urine
• intermittency – when passing urine, the flow stops and starts
• abdominal bloating or a feeling of incomplete emptying
• loin or abdominal pain

Methods to encourage bladder movement

It is very important that you empty your bladder as much as possible.

A change of lifestyle could have a positive impact on your overall health and organ function. Recording a bladder diary to track your bladder behaviour could help you to monitor your bladder function. If the condition still persists despite your lifestyle adjustments, do not hesitate to see your doctor immediately.

Here are some methods which could help your bladder movement.

Oral fluids modification

Water is the recommended oral fluid, according to the British Nutrition Foundation.

Drinking the recommended six to eight glasses of water every day has a lot of benefits like boosting energy and flushing the toxins from your body. The British Nutrition Foundation (opens in a new tab) recommends that at least half of the liquids you consume should be water. However, you should always check any pre-existing condition, and adjust your daily intake accordingly.

Moderate caffeine and alcohol intake

Caffeinated drinks, carbonated drinks and alcohol can fill your bladder much faster due to their components. This can create urinary urgency and over-extend you bladder, especially if you are out and do not have immediate access to a bathroom. You could develop incomplete bladder emptying and bladder injury if your bladder is overstretched.

Weight management

Losing weight may help to reduce urinary frequency. Regular exercise, eating right, and maintaining a healthy weight will encourage better bladder health because a proper balance of nutrition helps maintain normal organ function.

Improve your bowel movement

Good bowel function can allow the neighbouring bladder to function better. Bowel dysfunction such as irritable bowel syndrome (IBS) and constipation could cause bladder problems. Maintaining and improving your digestive system by eating fibre-rich food is very important.

Try avoiding constipation whenever possible. This can be helped by increasing the amount of fibre in the diet and exercising for at least 30 minutes most days of the week.

Drinking enough water is also important to prevent constipation. You should not neglect drinking sufficiently in the hope that this will reduce the number of times you go to the bathroom.

Don’t hold your pee in

Prolonging the urge to pee can stress your bladder muscles and increase the chance of getting an infection. Taking time for the bladder to be completely empty when you’re at the toilet can avoid high post-voiding residual volume which could cause infection.

Avoid food irritants

Some kinds of food can irritate your bladder, like spicy ingredients and citrus. You could try to avoid certain types of food and observe any change if you are not sure what food causes irritation to your bladder.

Stop smoking

Smoking can increase the risk of bladder cancer in the long term. It can also act as a bladder irritant because of the substances it contains, most notably nicotine.

Strengthen your pelvic floor muscles

Pelvic floor exercises to strengthen the muscles around the bladder can reduce the incidence of incontinence (opens in a new tab) as well as improve bladder voiding. Examples of these exercises include Kegel exercises, which can support your bladder wall and bowels, and improve your sexual health. Both men and women can benefit from these, and they can improve the control of your bladder as you age.

Techniques to help bladder emptying

The number of times a person may void urine can vary. It is normal to go six to eight times a day. For someone who goes to the bathroom more frequently than this, there are techniques they can try to ensure they can empty their bladder more fully. Importantly, a person should check with their doctor before attempting any bladder emptying techniques, as urinary frequency is sometimes due to a urinary tract infection (opens in a new tab). If there is an infection, this should be treated with antibiotics (opens in a new tab).

Double voiding

This technique is especially effective for people who feel like their bladder is not empty, or who return quickly to the bathroom after voiding.

The steps to double voiding are as follows:

• sitting comfortably on the toilet and leaning slightly forward
• resting the hands on the knees or thighs, which optimises the position of the bladder for voiding
• urinating as normal, focusing on emptying the bladder as much as possible
• remaining on the toilet, waiting anywhere from 20 to 30 seconds
• leaning slightly further forward and urinating again

People may also benefit from rocking side to side as this can result in better bladder emptying. However, a person should not rock from side to side if they cannot safely position themselves on the toilet.

There are additional variations to double voiding:

Standing up and walking around for 10 seconds before returning to the toilet. However, a person should never strain when they are passing urine as this can affect the pelvic floor muscles.

According to one study, people who used the double voiding technique had a lower incidence of bacteria in their urine (opens in a new tab) than those who did not.

Additional techniques to help bladder emptying

There are other techniques besides double voiding that a person can use to empty the bladder and reduce urinary frequency.

The Credé manoeuvre

Sitting on the toilet and leaning slightly forward before urinating. A person should place each hand above their pubic bone, press slightly inward toward their stomach, and begin urinating. They should continue to push toward the bladder as they void. This can help to increase the amount of urine expelled from the bladder.

Running water

Listening to running water can enhance a person’s ability to empty the bladder.

Bladder percussion

Tapping on the bladder with slight pressure can cause contractions that will help pass urine. A person should continue to tap for a few seconds even after the bladder seems fully emptied.

Stimulation therapy

Touching certain areas of the body may stimulate the passing of urine. Stimulation methods include pulling on the pubic hairs and massaging the lower stomach or the inner thighs.

Vibration therapy

Vibration therapy involves holding a vibrating device on the lower abdomen. Vibrations can stimulate the bladder and encourage emptying.

In addition to these techniques, a person should remember the importance of their environment when voiding. A quiet environment, where you doesn’t feel rushed, is very important to completely emptying the bladder.

Hopefully, this information will help you to maintain a healthy bladder.

Contact details

Uro-gynaecology specialist nurses:01223 349 239.

References

Rachel Nall, MSN CRNA (opens in a new tab) (03Apr2017) A guide to double voiding and bladder-emptying techniques (opens in a new tab), medically reviewed by Alana Biggers, MD MPH

Bladder and Bowel Community (2022) Health.com 30/01

Therapy services (2012) Patient and Carer Information: reduced bladder emptying. PICG approval date 16/08

The urology group (11Apr2023) Techniques for Complete Bladder Emptying (opens in a new tab)

The Specialist Continence Service (2012) Reduced bladder emptying patient care information. Harrogate and District NHS. Reviewed 2016

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