Incomplete bladder emptying, known clinically as urinary retention, occurs when urine remains in the bladder after urination. A healthy bladder typically retains 80 milliliters or less of urine after voiding. Residual urine can lead to several health complications, including an increased risk of urinary tract infections because stagnant urine provides a breeding ground for bacteria. Chronic retention can also contribute to bladder stones and potentially impair kidney function.
Practical Techniques for Full Emptying
Achieving a complete void often begins with proper positioning on the toilet. Sit fully on the toilet seat with your feet flat on the floor, using a small stool if necessary. This posture helps relax the pelvic floor muscles, allowing urine to flow freely. Leaning forward slightly, with hands resting on your knees or thighs, optimizes the angle of the bladder neck for efficient drainage.
Conscious relaxation is important, as straining or pushing can be counterproductive. Urination should be initiated by relaxing the abdominal and sphincter muscles, not by forceful bearing down. Straining can weaken the pelvic floor and may cause the bladder neck to close prematurely, leaving urine behind. Instead, focus on a steady, unforced stream until the flow stops naturally.
One highly effective method is “double voiding” or staggered emptying. After finishing the initial stream, remain seated for 20 to 30 seconds. Gently rocking your pelvis forward and backward or side to side during this pause can help. Then, try to urinate again, as this technique encourages the bladder muscle to contract a second time and release residual volume.
Mechanical stimulation can also encourage the bladder to empty more completely. Gently tapping the area directly over the bladder, just above the pubic bone, is called bladder percussion. This rhythmic tapping helps stimulate the detrusor muscle, prompting a stronger final contraction. A light massage of the lower abdomen can similarly assist in manually expressing the last amounts of urine.
Identifying Symptoms of Incomplete Emptying
Recognizing the signs of incomplete emptying, or chronic urinary retention, is the first step toward addressing the issue. The most common complaint is the persistent feeling that the bladder is not empty, even immediately after using the restroom. This sensation often prompts a person to attempt to urinate again within minutes of their last void.
The flow of urine itself may show objective signs of a problem. Individuals often experience a hesitant stream, meaning they must strain or wait to start urinating. The stream may also be weak, slow, or intermittent, stopping and starting unexpectedly.
Another telling sign is post-void dribbling, where small amounts of urine leak out shortly after the main stream has finished. An increase in urinary frequency is common, requiring the person to go to the bathroom much more often than usual. This constant residual volume can also lead to a more intense sense of urgency.
Underlying Reasons for Urinary Retention
Incomplete bladder emptying is often a symptom of an underlying physical or neurological issue affecting the urinary tract. The most common cause in men is a physical obstruction, typically benign prostatic hyperplasia (BPH), or an enlarged prostate. As the prostate gland grows, it compresses the urethra, blocking the outflow of urine.
In women, a common obstructive cause is pelvic organ prolapse, such as a cystocele, where the bladder bulges into the vagina and kinks the urethra. Urethral strictures, which are narrowings of the urethra from scar tissue, can also impede the passage of urine in both sexes. Chronic constipation can also contribute by causing a full colon to press on the bladder, preventing effective expansion and contraction.
Neurological conditions can disrupt the communication pathway between the brain and the bladder, resulting in the failure of the detrusor muscle to contract or the sphincter to relax properly. Damage from conditions like diabetic neuropathy, multiple sclerosis, stroke, or spinal cord injuries can impair this signaling. This disconnect prevents the bladder from effectively signaling fullness or executing the command to empty.
Certain classes of medications are known to interfere with bladder function and can cause or worsen retention. Drugs with anticholinergic properties, such as some antidepressants, can inhibit the bladder muscle’s ability to contract. Similarly, alpha-adrenergic agonists found in decongestants can tighten the muscles in the bladder neck, increasing resistance to urine flow.
When to Seek Medical Guidance
While simple techniques can often resolve minor issues, certain symptoms warrant prompt medical evaluation. The sudden, complete inability to pass urine, known as acute urinary retention, is a medical emergency. This condition causes extreme lower abdominal pain and requires immediate decompression of the bladder via catheterization to prevent damage to the upper urinary tract.
You should also consult a healthcare provider if you experience persistent pain, burning during urination, or an unexplained fever. These symptoms may suggest a developing urinary tract infection, a common complication of residual urine. Any instance of blood in the urine (hematuria) should be promptly investigated by a physician.
If basic emptying techniques do not resolve your chronic symptoms, a doctor can perform diagnostic tests. One common procedure is a post-void residual (PVR) volume test, which uses ultrasound to measure the amount of urine left in the bladder after voiding. This test helps determine the severity of the retention and guides the selection of appropriate medical or surgical treatment.