INCOMPLETE BLADDER EMPTYING
A common complaint from women is the feeling of incomplete bladder emptying. This can be due to bladder irritation and incoordination of brain/bladder/pelvic floor, or a bladder prolapse. These symptoms can present an urge to urinate shortly after having just emptied (constant urge to urinate) or post void dribbling (leaking after urination) depending on the reason.
When the bladder is irritated, emptying will not feel satisfying due to inflammation and incoordination. This is not to say that the bladder isn’t actually empty yet, it will give the feeling of not being empty resulting in feeling the need to urinate often to ’empty’ the bladder. Often times it is empty, however, due to poor bladder health (diet, voiding habits) and training of the bladder to empty frequently the brain, bladder, and pelvic floor are not getting the proper signals (incoordination) that the bladder has emptied, resulting in the need to urinate often due to feeling of incomplete emptying. Bladder Retraining including following a voiding schedule and water guidelines is the best treatment for this. Teaching your bladder to not empty until it is full (see What is Normal) will allow the brain, bladder, and pelvic floor muscles to coordinate again and the feeling will resolve. It is important to remember that we always have urine in our bladder, so just because you CAN urinate, doesn’t mean you SHOULD urinate. We do not void 100% of our urine out with each void (normal residual urine is 10%) and our kidneys are constantly making urine, so as soon as you walk away from the toilet, the kidneys started filling the bladder up again. Give it time to fill up before your next void, despite the feeling. Teaching your bladder to empty before it is full will lead to bladder dysfunctions including incontinence, urinary frequency, and feeling of incomplete emptying, as well as pelvic pain.
POST VOID DRIBBLE
However, when you have a prolapse it may be difficult to empty your bladder and this may result in post-void dribble. You may feel empty but when you stand up or walk away from the toilet a few more drops may leak out. Post-void dribble can also occur if you do not take the time to urinate or hover above the toilet (regardless of a prolapse). You must allow your pelvic floor to relax and the bladder to contract fully to empty completely (so don’t hover and take a few relaxing breaths!)
Here are some techniques to facilitate bladder emptying:
- Sit on the toilet with your feet on a stool and your forearms resting on your knees. This will tip the bladder forward. Close your eyes and focus on diaphragm breathing so your pelvic floor muscles can fully relax. Do not push or force the urine out, this will inhibit bladder function and make the problem worse long term.
- Once the urine stream has ended, stand up and then sit back down on the toilet and resume above position. If you have a prolapse, this will allow the urine that was in the ‘pocket or prolapse’ of the bladder to shift over the urethra. When you sit back down more urine may come out.
- Lastly, perform 5 quick Kegels to remind the bladder that it can relax now. This will improve the coordination between the brain, bladder, and pelvic floor. Remember, you are NOT performing a Kegel during urination! This techniques should be performed once the urine stream has ended and only if necessary.
I do not recommend performing Kegels after urination (the last listed step above) unless all other strategies have failed. It is meant to remind the bladder to stop contracting but ultimately can be confusing to the reciprocal relationship of the pelvic floor muscles and bladder if performed often. Save this technique as a last resort and do not do it every time after urination.