Empty your bladder and overcome incomplete bladder emptying with this instructional video by Michelle Kenway Pelvic Floor Physiotherapist.
This bladder emptying video shows you how to:
- Start bladder emptying
- Improve bladder flow
- Empty your bladder completely
- Avoid straining to empty your bladder
Pelvic Pain and Pelvic Relaxation Physiotherapy (Audio Download)
Physiotherapy home management program with Pelvic Floor Physiotherapist Michelle Kenway. Designed for women with pelvic pain and pelvic muscle spasm conditions including:
- Painful intercourse
- Post partum pain
- Pelvic nerve pain
- Vulvar pain (vulvodynia)
- Interstitial cystitis
- Pain after pelvic floor surgery (hysterectomy, prolapse or incontinence surgery)
- Sexual abuse and emotional distress
Bladder Emptying Video Suitability
- Incomplete bladder emptying (urinary retention)
- Recurrent bladder infection (resulting from urinary retention)
- Difficulty starting the flow of urine (hesitancy)
- Slow stream (slow flow)
- Bladder emptying problems after pelvic surgery (including after a hysterectomy, prolapse repair or bladder surgery)
- Pelvic floor muscle tension
- Pelvic pain conditions
Causes of Incomplete Bladder Emptying
Bladder emptying problems can result from a range of causes including:
- Some medications e.g. opioids
- Nerve problems e.g. stroke
- Reduced bladder contractility
- Blocked urine tube e.g. pelvic organ prolapse
- Pelvic floor muscle spasm
Symptoms of Incomplete Bladder Emptying
Common symtpoms include:
- Slow stream (i.e. urine flow)
- Lower abdominal discomfort
- Inability to void
- Sensation of bladder fullness or incomplete emptying after voiding
If you suffer from undiagnosed bladder emptying problems, please consult your medical practitioner.
If you’re unable to empty your bladder after having already tried to do so, please attend your local hospital emergency department. Bladder overfilling can have serious long-term consequences and needs to be treated promptly.
Normal Bladder Emptying
- Being able to start the flow of urine without straining.
- Start the flow of urine without straining.
- The flow of urine should be strong and continuous without needing to strain.
- Feeling as though you have completely emptied your bladder when you have finished voiding.
- Having the ability to empty almost all of the urine the bladder has stored.
- It is considered normal to have less than 50 ml (1.6907 fl oz) of urine remaining in the bladder after emptying. The remaining bladder volume left in the bladder is called the ‘residual volume’.
- The normal amount the bladder can store varies between individuals.
- The bladder can stretch and store 450-500 mls (13.53 fl oz to 16.91 fl oz).
- It’s normal to empty the bladder every 3-4 hours. This time interval varies depending upon the amount of urine remaining in the bladder after voiding, bladder conditions such as urinary urgency, the amount of fluid consumed along with other factors.
Straining to empty your bladder can damage your pelvic floor which can worsen bladder problems. Urine retained in the bladder after emptying can increase your risk of bladder infection.
Correct Bladder Emptying Position
1. Sitting Position
Using the correct sitting position is very important for emptying your bladder and overcoming incomplete bladder emptying.
- Start by sitting on the toilet seat and never hover or stand leaning over the toilet seat
- Position both feet fully supported on the ground or on a footstool (1)
- Keep your knees and hips apart
- Lean forwards and support your trunk in this position by resting your hands or elbows/forearms on your thighs (2,3)
- Keep the inward curve in your lower back during bladder emptying. (2,3)
2. Squatting Position
Squatting to empty the bladder over a squatting toilet at ground level is practiced widely in some countries e.g. India and Asia. Squatting is an ideal position for bladder emptying and it’s the position that the human race used prior to the development of the modern day sitting toilet. If you’re able to squat and have the facilities to do so, this position is ideal for bladder emptying. (4)
Correct Bladder Emptying Technique
- Visit the bathroom when you feel an appropriate urge to empty your bladder rather than emptying ‘just in case’
- When you sense the urge to empty your bladder relax your pelvic floor openings while sitting on the toilet seat. This action can be achieved by relaxing your lower abdomen and allowing your belly to bulge forwards as you empty.
- If you can’t start bladder emptying then you may try turning on a tap to produce the sound of running water. This is because sometimes the sound of tricking water can help trigger bladder emptying.
- Keep your belly relaxed forwards until the stream stops.
- Avoid straining to empty.
- When you sense you’ve finished emptying your bladder, lift and squeeze your pelvic floor muscles.
Double Void Techniques for Incomplete Bladder Emptying
If you feel that your bladder isn’t completely empty, then you may like to try any of the following double void techniques:
- Rock side to side while sitting on the toilet seat by shifting your weight from one buttock and thigh to the other before trying to empty your bladder again.
- Stand up and rotate your hips as if rotating a hula hoop around your waist.
- Stand up and walk around briefly before attempting to start voiding again.
- Use both hands above your pubic bone at the front to gently press inwards with the pads of your fingers. You can press your bladder directly above and behind your pubic bone.
Physiotherapy Tips to Improve Bladder Emptying
- Avoid overfilling your bladder, when it’s too full it can be very difficult to empty this means knowing that you need to empty 3-4 hourly (or around 250-400 mls of urine) depending on your fluid intake
- Stay well hydrated and drink at steady intervals during the day rather than all at once to avoid sudden bladder filling
- Take your time to empty your bladder completely every time you empty rather than rushing
- Avoid emptying ‘just in case’ and empty with the appropriate urge
- If you have trouble emptying your bladder because of reduced bladder sensation you may need to go on a timed voiding (emptying) program that involves attempting to empty your bladder at scheduled time intervals regardless of whether or not you feel the urge to void (5)
- Reduce your intake of diuretics such as caffeine and alcohol because they draw extra fluid into the bladder.
1.Wennergren HM, Oberg BE, Sandstedt P. The importance of leg support for relaxation of the pelvic floor muscles. A surface electromyograph study in healthy girls. Scand J Urol Nephrol. 1991;25(3):205-13. https://doi: 10.3109/00365599109107948. PMID: 1947848.
2. Sapsford R. The pelvic floor. A clinical model for function and rehabilitation. Physiotherapy. 2001;87(12):620–630. doi: 10.1016/S0031-9406(05)61107-8.
3. Clothier JC, Wright AJ. Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment. Pediatr Nephrol. 2018;33(3):381-394. https://doi:10.1007/s00467-017-3679-3
4. Rane, Ajay (2011) Does posture affect micturition? PhD thesis, James Cook University. https://researchonline.jcu.edu.au/29819/1/29819_Rane_2011_thesis.pdf
5. Jean-Jacques Wyndaele (2008) Conservative Treatment of Patients with Neurogenic Bladder european urology sup plements 7 (2008) 557–565 https://doi.org/10.1016/j.eursup.2008…
ABOUT THE AUTHOR, Michelle Kenway
Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support, along with Dr Judith Goh Urogynaecologist.