If your bladder is not emptying completely, you may experience symptoms like urgency, frequency, or incontinence. There are a few key signs that can help identify if your bladder is not emptying properly.
Frequent urination
If you find yourself needing to urinate much more often than usual, this is one of the most common signs of an underactive bladder. Frequent urination is defined as needing to urinate 8 or more times in a 24-hour period. With a healthy bladder, most people only need to urinate about 6-8 times per day. When your bladder cannot fully empty, urine will build up quicker, causing the urge to urinate more often.
Urgency
Bladder urgency refers to a sudden, intense urge to urinate. This feeling can seem to come out of nowhere and may be difficult to control. Bladder urgency often goes hand in hand with urinary frequency. When your bladder cannot empty all the way, you may feel an urgent need to go even when only a small amount of urine is present.
Urinary incontinence
Incontinence means you experience accidental leakage of urine. This happens when your bladder reaches its maximum capacity and urine unavoidably leaks out. Urinary incontinence can range from mild to severe. Mild incontinence involves a few drops of urine leakage, while severe cases involve larger amounts. Incontinence is a common symptom of an underactive bladder, since your bladder may reach its capacity quicker when it cannot empty fully.
Straining to urinate
You may find you have to strain or push in order to get urine flow started. Straining can also occur during voiding, as you try to squeeze out all the urine from your bladder. This straining indicates your bladder muscle has become too weak to fully empty itself.
Weak urine stream
Along with straining, you may notice your urine stream is not as strong as it normally is. Your urine flow may dribble, trickle, or even stop and start. A weakened urine stream is another effect of inadequate bladder emptying and weakened bladder muscles.
Feeling of incomplete emptying
After you urinate, you might still feel like your bladder is still full. This lingering feeling of needing to go is typically due to urine remaining in your bladder after voiding. Even just a small amount of urine left behind can lead to bladder irritation and signals your bladder is not emptying as it should.
Bladder or lower abdominal pain
In some cases, struggling to empty your bladder can cause pain or discomfort. You may feel bladder pressure, bladder fullness, or aching in your lower abdomen. Bacteria multiplying in pooled residual urine can also potentially lead to infections, which can cause bladder pain or cramps.
Cloudy or foul-smelling urine
When urine sits stagnant in your bladder, it provides an environment for bacteria to grow. This can sometimes cause cloudy or discolored urine, which may also have a foul or strong odor. So if you notice your urine looks or smells abnormal, it could be related to incomplete bladder emptying.
Seeing a doctor
If you are experiencing any symptoms of inadequate bladder emptying, it is important to see your doctor. They can perform tests to evaluate your bladder function and determine if there is an underlying condition causing incomplete emptying.
Some common tests include:
- Post-void residual test – Measures how much urine is left in the bladder after voiding.
- Uroflowmetry – Records the urine flow rate, flow pattern, and volume voided.
- Cystoscopy – Uses a tiny camera inserted in the urethra to view the inside of the bladder.
- Bladder scan – Uses ultrasound to provide an image of the bladder and residual urine.
Causes of incomplete bladder emptying
There are a number of possible underlying causes for inadequate bladder emptying, including:
Weak bladder muscles
The bladder muscle, known as the detrusor, can become damaged or weakened. When this happens it cannot fully contract to squeeze out all urine from the bladder. This can be due to conditions like overactive bladder, underactive bladder, neurogenic bladder, bladder exstrophy, or bladder diverticulum.
Nerve damage
Nerves carry signals between the bladder and brain to coordinate urination. If these nerves become damaged, it can disrupt normal bladder function and emptying. Neurological conditions like multiple sclerosis, Parkinson’s disease, stroke, or spinal injury can cause nerve signaling problems.
Obstruction
Something blocking the urethra or ureter tubes can prevent proper urine transport and drainage from the bladder. This could be due to kidney stones, prostate enlargement, urinary tract strictures, cystocele, rectocele, or uterine prolapse.
Bladder stones
Hard deposits or bladder stones in the bladder can obstruct flow and lead to pooling of urine. This provides an environment for bacterial growth.
Urinary tract infection
UTIs may cause bladder inflammation or swelling that blocks the outflow of urine. Chronic UTIs can also damage bladder tissue over time.
Medications
Certain types of medications like anticholinergics, antihistamines, decongestants, opioids, and calcium or sodium channel blockers can impact bladder function, relax the bladder muscle, and impair emptying.
Aging
As we age, bladder muscles can weaken, and bladder capacity diminishes. Older men may also develop prostate enlargement that obstructs urine flow.
Pregnancy
Hormonal changes, pressure from the uterus, and muscle stretching during pregnancy can contribute to incomplete bladder emptying.
Post-surgery
Bladder trauma, nerve damage, or scarring from pelvic surgery (like a hysterectomy) may impact the bladder’s ability to empty normally during the healing process.
Diabetes
Poorly controlled blood sugar from diabetes can damage nerves that control bladder function and weaken bladder muscles over time.
Other diseases
Medical conditions like multiple sclerosis, Parkinson’s, stroke, tumors, and myasthenia gravis affect nerve signaling and may impair bladder emptying.
Bladder outlet obstruction
Any structural blockages around the urethral opening can obstruct bladder emptying. This includes uterine prolapse, urethral strictures, bladder stones, cystocele, enlarged prostate, and some cancers.
Evaluating post-void residual urine
A key test used to diagnose incomplete bladder emptying is checking post-void residual urine. This measures how much urine is left over in the bladder after voiding. There are a few different ways this can be checked:
Catheterization
This involves inserting a thin catheter tube into the urethra to drain any urine left in the bladder after voiding. The amount of drained urine is measured. A residual amount of more than 50-100 mL may indicate inadequate emptying. Catheterization provides the most accurate measurement but is mildly invasive.
Bladder ultrasound
Ultrasound uses harmless sound waves to create a picture of the bladder. It can accurately estimate post-void residual urine volume without catheterization. Ultrasound may be done on the lower abdomen or transvaginally in women.
Bladder scan
This portable, non-invasive tool also uses ultrasound to visualize the bladder and quickly estimate residual urine. It is slightly less accurate than traditional ultrasound but very convenient in clinical settings.
Treating an underactive bladder
Treatment will depend on the specific cause of your incomplete bladder emptying. Some general treatment approaches may include:
Medications
Muscle relaxants, prescription bladder antispasmodics, and antibiotics for UTIs may help improve bladder emptying.
Catheterization
Using a catheter periodically to drain the bladder if you have high post-void residuals.
Lifestyle changes
Timed voiding, double voiding, fluid intake modification, bladder retraining, and pelvic floor exercises can help strengthen bladder muscles.
Devices
Urethral inserts like ReliOn can help keep the urethra open to improve bladder emptying in women. Some intermittent catheters are also designed to enhance urine flow.
Surgery
Surgical procedures to remove bladder obstructions, divert urine flow, or enlarge the bladder may be options depending on the specific anatomy.
Preventing urinary retention
Some tips to help promote complete bladder emptying and prevent urine retention include:
- Urinate on a scheduled time pattern rather than waiting for urges
- Sit on the toilet leaning forward with feet flat on the floor
- Avoid rushing urination – relax and take your time
- Perform double voiding – urinate, relax, then urinate again
- Do Kegel exercises to strengthen pelvic muscles
- Stay hydrated and avoid caffeine and acidic foods
- Use the restroom more frequently if needed
- Maintain a healthy weight
- Don’t ignore urges and resist delaying urination
When to see a doctor
You should make an appointment with your physician if you notice any persistent symptoms of an underactive bladder or incomplete emptying. Timely evaluation and treatment is important to prevent complications.
See your doctor right away if you experience:
- Inability to urinate at all
- Excruciating bladder pain
- Continuous urine leakage
- Groin pain
- Recurring UTIs
- Blood in your urine
These could be signs of a serious medical problem requiring urgent treatment. Left untreated, impaired bladder emptying can potentially lead to permanent bladder damage over time.
Takeaway
An underactive bladder that does not empty completely can reduce your quality of life. Make sure to watch for common symptoms like frequent urination, sudden urges to go, weak urine stream, and feeling of incomplete emptying after voiding. Talk to your doctor if you think your bladder function is impaired – there are many effective treatments to help restore normal emptying.
