The bladder is a highly sophisticated, muscular organ that is responsible for the key bodily function of safely storing and then efficiently excreting waste products from our bodies, in the form of urine, at a time that is under our control and is socially convenient.
We take our bladder for granted, but when it stops working properly it can have significant physical, social and psychological impacts. Incomplete bladder emptying is often a hidden problem with the affected person having little or no idea that they are not emptying their bladder properly.
It can be caused by conditions that narrow or block the bladder outlet or urethra (waterpipe), such as enlargement of the prostate in men as they age or urethral strictures (scarring of the waterpipe), constipation or vaginal prolapse.
It may also be caused by conditions that weaken the bladder so that it is unable to contract effectively and push the urine out, such as general aging of the bladder, persistent untreated blockages of the bladder outlet or urethra (as described above), neurological problems and nerve damage secondary to conditions such as diabetes, Multiple Sclerosis (MS), Parkinson’s disease, spinal cord injury or Cauda Equina syndrome.
Although there are no specific symptoms associated with incomplete bladder emptying you may notice that you are going to the toilet more frequently and passing smaller volumes of urine.
In addition, you may have the feeling that your bladder hasn’t fully emptied after you go to the toilet leaving you feeling like you need to go again. Other symptoms include leaking urine after peeing or the development of recurrent urinary tract infections (UTIs).
UTIs are common – they occur when bacteria get into the bladder and trigger inflammation of the bladder wall. This can cause pain, an urgent and frequent sensation of needing to pee, cloudy and sometimes bloodstained urine, which is often foul smelling, and a general feeling of being unwell.
More than 50% of women will experience a UTI in their lifetime, while the number of men affected is lower. This is in part due to the fact that the female urethra is much shorter and therefore it is easier for bacteria to reach the bladder. Menopause also plays a role as hormonal changes lead to alterations in the normally protective bacterial environment of the vagina and vulval area.
There are many other risk factors involved in the development of a UTI including inadequate fluid intake, a previous UTI, sexual activity, pregnancy, use of spermicides, poor hygiene of the genital area, a weakened immune system (e.g. diabetes, chemotherapy), catheters or surgical procedures on the urethra or bladder and incomplete bladder emptying.
Many of the risk factors are interlinked. If you are not emptying your bladder properly infected urine is not being flushed away when you pee and therefore the infection is more difficult to clear.
An inadequate fluid intake can lead to constipation, which in turn can cause poor bladder emptying. All of these can be underlying factors in the development of UTIs, especially in young children and the elderly. In addition, poor hygiene in the genital area can also contribute to the risk of UTI.
It is therefore really important to teach children good bladder habits, from the time of potty training onward, that they can maintain lifelong.
One of the key factors for good bladder emptying is to give yourself enough time. Invariably we are always in a rush to finish.
An easy practice to adopt is to stay at or on the toilet after you think you have finished peeing, count slowly to 10 and then try again. This is often termed ‘double-voiding’ and in many cases will be enough to empty the last small volume of urine that would otherwise be left behind.
In addition, making sure you relax your pelvic floor and abdomen (you shouldn’t have to push to pee) and leaning forward slightly or elevating your feet, should all help ensure you empty your bladder well.
Mary Garthwaite is the The Urology Foundation Chair and a former Consultant Urologist.