Bladder Emptying Techniques for Avoiding UTI with Prolapse

Do you suffer from UTI (urinary tract infection or cystitis)?

Do you have bladder emptying problems?

Bladder emptying problems can increase your risk of UTI.

Prolapse and prolapse surgery can both cause bladder emptying problems.

This Physiotherapist information teaches you how to empty your bladder and reduce your risk of UTI with prolapse problems and after prolapse surgery.

Read on now to learn:

• What is UTI
• UTI symptoms
• UTI diagnosis
• UTI after prolapse surgery
• UTI with bladder emptying problems
• How to empty your bladder 
• Correct emptying position 
• Correct emptying technique
• ‘Double Void’ technique for overcoming incomplete emptying

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1.What Is UTI? 

UTI is an infection in any part of the urinary tract (shown right)

The urinary tract includes:

• bladder
• urethra
• kidneys
• ureters

If you’re retaining urine and not emptying your bladder completely, your normal bladder cleaning mechanism gets disrupted promoting bacterial growth, colonisation and UTI.

2. UTI Symptoms

UTI symptoms for many (not all) women include:

• Pain with urination
• Frequent bladder emptying
• Bladder urgency
• Bladder incontinence with urgency
• Frequent bladder emptying at night

Some women notice that their urine smells or contains blood.

3. How Is UTI Diagnosed? 

UTI is diagnosed with urine testing that results in a positive urine culture.

Many women have symptoms of bladder irritation such as urinary frequency and urgency that are not caused by a bladder infection.

4. UTI After Prolapse Surgery

UTI is the most common post operative problem after prolapse surgery.¹

Incomplete bladder emptying is one of the major risks for getting a UTI after prolapse surgery.²

Incomplete bladder emptying and UTI early following prolapse surgery can be caused by a range of factors including:

• Internal swelling
• Internal bruising
• Medications (opiods for pain relief)
• Catheterisation
• Nerve damage

Some women need to use a catheter temporarily after prolapse surgery until sufficient postoperative healing allows them to empty their bladder without assistance.

5. Bladder Emptying Problems with a Prolapse

Women with bladder prolapse (cystocele) often have bladder emptying problems. This can occur when the urine pockets into the prolapsed tissue rather than emptying normally.

Sometimes a large rectocele (posterior vaginal wall prolapse) can cause a kink in the urethra (urine tube) making it difficult to completely empty the bladder.

Pelvic prolapse can cause bladder emptying problems including:

• Slow bladder emptying
• Incomplete bladder emptying where the bladder doesn’t fully empty

Women with pelvic floor problems who retain more than 30 mls  or 1oz of urine in the bladder have increased risk of UTI.³

6. How to Empty your Bladder

Emptying your bladder involves using the same position and technique described next either with a prolapse or after having prolapse surgery.

If you’re having trouble emptying your bladder go with the urge – this is not the time for bladder control training where women are encouraged to defer emptying with the urge.

7. Position for Optimal Bladder Emptying

• Sit on the toilet seat – don’t hover over the seat
• Support your trunk by placing your hands on your knees or thighs
• Spread your knees and hips wide
• Position your feet flat with each resting on a telephone book or wrapped toilet rolls*
• Lean forwards from your hips
• Maintain the normal inward curve in your lower back

*This is optional for getting the knees higher than the hips. Some women find this raised knee position helpful, others don’t.

8. Technique for Effective Bladder Emptying

• Empty when you sense the appropriate urge
• Bulge your abdomen forwards and make your waist wide as you empty
• Relax your pelvic floor muscles
• Breathe normally
• Take your time

9. Double Void Technique for Overcoming Incomplete Emptying

Double void can be a very useful technique to help overcome incomplete emptying.

You may use this technique to empty residual or retained urine having just emptied your bladder.

• Stand up
• Rotate your hips as if doing hula hoop in one direction
• Rotate using the same action in the other direction
• Rock your hips and pelvis back and forwards
• Rock your hips and pelvis side to side
• Sit back down and repeat your voiding technique

While this technique is called ‘Double Void’ which implies 2 attempts at emptying however it can be used as many times as you choose to help you empty your bladder more effectively.

10. Bladder Emptying Tips

• Never strain to empty your bladder.
• Running water helps some women initiate emptying. Try turning on the tap if you’re having difficulty getting started.
• Monitor and control your caffeine intake. Caffeine is a diuretic and increases the volume of urine in the bladder.
• Emptying the bowel helps some ladies with large rectocele empty their bladder
• Pat dry front to back
• Wear breathable cotton briefs

If you have prolapse issues and suffer from recurrent UTI, using the correct bladder emptying technique and taking your time to promote complete emptying might help you reduce your overall UTI risk.

1. Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356:2143–55. doi: 10.1056/NEJMoa070416.

2. Kringel U, Reimer T, Tomczak S, Green S, Kundt G, Gerber B. Postoperative infections due to bladder catheters after anterior colporrhaphy: a prospective, randomized, three-arm study. Int Urogynecol J. 2010;21:1499–504. doi: 10.1007/s00192-010-1221-2.

3. Haylen B, Lee J, Husselbee S, Law M, Zhou J. Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction. Int Urogynecol J. 2009;20:837–42. doi: 10.1007/s00192-009-0856-3.