Double voiding is a simple, non-invasive behavioral strategy used to empty the bladder more completely during a single restroom visit. Healthcare providers often recommend this technique to address incomplete bladder emptying. The core concept involves urinating twice with a short rest period in between, aiming to expel any urine remaining after the initial attempt. By relaxing and repositioning, the technique encourages the bladder muscle to contract a second time, reducing the volume of leftover urine.
Performing the Double Void Technique
The technique begins with sitting comfortably and fully on the toilet seat, ensuring the feet are flat on the floor to promote pelvic muscle relaxation. The individual should lean slightly forward, resting their hands on their knees or thighs, which helps to align the bladder for optimal emptying. The first voiding should proceed naturally, without any straining or pushing, until the flow stops on its own.
Once the initial flow stops, remain seated and wait for a short period, typically 20 to 30 seconds. This rest allows the detrusor muscle a chance to relax and potentially contract again. After the pause, try leaning slightly further forward or gently rocking side to side to change the bladder angle.
The second attempt to urinate should be done by relaxing and letting the urine flow out naturally. Avoid straining or pushing during this second void.
Medical Reasons for Double Voiding
The primary problem that double voiding seeks to address is post-void residual (PVR), which is the presence of urine remaining in the bladder after urination. PVR occurs when the bladder muscle (detrusor) is too weak to contract fully, a condition known as detrusor underactivity or bladder hypotonia. Neurological disorders, such as diabetes-related neuropathy, multiple sclerosis, or spinal cord injury, can disrupt the nerve signals required for a strong bladder contraction.
Incomplete emptying can also be caused by outflow obstruction, such as an enlarged prostate in men or a prolapsed pelvic organ in women. When urine remains stagnant in the bladder, it creates an environment where bacteria multiply rapidly. This increases the risk for recurrent urinary tract infections (UTIs), bladder stones, or even kidney damage.
Measuring Success
The effectiveness of the double voiding technique is assessed using both subjective and objective measures. Subjectively, individuals often report a reduction in urinary frequency and urgency, as well as a more complete feeling of bladder emptiness after using the restroom. They may also notice a decrease in the number of times they experience small urine leaks or have to return to the bathroom shortly after voiding.
Objectively, success is measured by a reduction in the Post-Void Residual (PVR) volume. This measurement is typically taken in a clinical setting using a non-invasive bladder scanner, which employs ultrasound, or less commonly, through temporary catheterization. While a PVR of less than 100 milliliters is often considered acceptable, the clinical goal is to consistently reduce PVR to a safer level, ideally below 50 milliliters, which correlates with a lower incidence of UTIs.