Bladder Emptying Techniques for Avoiding UTI with Prolapse

UTI and 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? Urinary tract

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 diagnosis

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 Slow

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.

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  1. I appreciate the info..have prolapse which was repaired a few years ago with surgery which needs repairing again I am now age77 and fairly fit for my age. But now have serious issues with bladder and looks like kidneys now affected…Have had two or three episodes recently with antibiotics..this time blood pressure seriously affected ie 189 over 101….up and down in the night …need prolapse fixed but nothing available for 5 months in NHS apparently….have a grandson 18 to be here for as daughter died 2017. So vital I get this dealt with now….

  2. I am almost 3 wks out from Cystocele repair, hysterectomy, and TVT surgery (all done vaginally). I had a Foley catheter for a week, have been able to urinate, but my urine seems to be cloudy….is this normal?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Brandy having a catheter can often cause problems after removal. You need to get to the hospital and get a urine test too, take care and all the best!

  3. Thank you for such informative information. I’m 4 days post surgery for a bladder prolapse repair and I’m only able to half empty my bladder. I’m having to self catheter. This helped me understand that trying harder or holding my bladder longer may not be the best strategy. I’ll stay the course and let the healing occur.


  5. Has anyone ever gotten a POP due to an abortion?

  6. thank you for the article! I am 9 weeks out from surgery, I had vaginal hysterectomy and repair for rectocele and cystocele and a sling for my urethra, a week after the first surgery I had a second surgery to loosen the sling because I could not get off the foley catheter. Then I had a problem emptying (a week after my second surgery I had almost 2 liters drained off at the doctor’s office) I had to self cath every time for about 4 weeks and it better but I am still self cathing 2-3 times a day because I don’t empty all the way and have had a couple of uti’s. Currently seems to be hovering around 150 ml’s during the day and 300-700 first thing in the a.m. The doctor said I could cut the mid day and before bed cathing when I feel like I’m emptying enough but because of nerve damageI have no sensation of anything being in there to begin with. I have to be very full to even feel the basic urge to go so I’m going to try the second voiding technique.

  7. I had the operation two week’s ago and seem to be recovering well. However, I am finding that I keep leaking – particularly when I go out walking. I have been using these techniques to try to empty the bladder before I go out, but this doesn’t seem to stop it. I even had to buy some panties and better pads this morning as the pad I had on was not sufficient. Will this eventually stop or is this a problem that I am going to have to put up with from now on? Am I expecting too much too early? I did have a short go (15 minutes) on my indoor cycling bike – the specialist said this would be ok after two weeks – could this have caused the leakage as I seemed to be fine over the weekend.

    • Michelle Kenway Physiotherapist says


      Thanks for your question I’m glad you’re recovering well. Bladder leakage after prolapse surgery can happen when the prolapse is repaired. Sometimes this exposes bladder leakage that might otherwise have been happening without the prolapse. A prolapse can actually kink the urethra we urine tube preventing bladder leakage. When this is repaired, the leakage can then occur. This may or may not be the reason that you are having these issues. It’s still early days and there is bound to be swelling impacting on your condition. It’s probably too early to be thinking about using an exercise bike-this is usually left until at least 6 weeks after surgery. The best thing to do to manage at the moment is to rest so that your body heals really well, try to walk daily as it feels comfortable and then when your surgeon allows you to start your pelvic floor exercises. This video will give you some idea on how to start pelvic floor exercises after prolapse surgery.

      All the best for your recovery,

      • Freeflyer says

        Thanks for the info, Michelle. I’ve reached the 6 week watershed and have been out on the bike a few times. As long as I use my legs I find it not too strenuous, although I have been very careful on the hills, and walked up any really steep ones. As you wrote, the leakage does seem to be getting better, although I think I have a way to go yet. I forgot recently when babysitting and playing hide and seek with my 8-year-old grandson. We ended up laughing uncontrollably in the pouring rain (although we were wearing raincoats), and I had been chasing him with slow running involved. Both the excitement and laughing had me rushing indoors to change the pad! I told myself off royally for forgetting to take it easy but don’t seem to have done any harm – at least, I do hope not. It’s very, very difficult to take it easy for such a long time when before the op one of the last things I ever did was keep still.

        • Michelle Kenway Physiotherapist says

          Thanks so much for the update! I’m really glad to hear that things are improving and yes it is difficult to take things easy for a long time but it’s the best way to get best healing with this type of surgery.
          All the best, Michelle

    • I had vaginal hysterectomy and cystecel surgery 6 weeks ago and have feelings of having a full bladder all the time and when I go I usually have urine come out. I was checked for a UTI 2 times and came back negative just was curious if anyone else has this problem.

  8. Thank you for a very interesting article.

    • Michelle Kenway says

      My pleasure Nadine, many women don’t realise that incomplete emptying is one cause of recurrent UTI and prolapse can make this retention worse.
      All the best