From the Guidelines
Incomplete bladder emptying can be managed through several approaches, including double voiding, timed voiding, and self-catheterization, with the goal of preventing complications such as urinary tract infections, bladder stones, or kidney damage. The most recent and highest quality study on this topic is from 2021, which provides guidance on the management of adult neurogenic lower urinary tract dysfunction, including the treatment of incomplete bladder emptying 1. According to this study, clinicians should discuss the specific risks of urinary retention and the potential need for intermittent catheterization prior to selecting botulinum toxin therapy. Some key points to consider in managing incomplete bladder emptying include:
- Double voiding, which involves urinating, waiting a few minutes, then trying again to empty the bladder more completely
- Timed voiding every 2-4 hours while awake to prevent overdistension
- Self-catheterization, typically performed 3-4 times daily using clean technique with a 14-16 French catheter, may be necessary in more severe cases
- Avoiding excessive fluid intake before bedtime and limiting caffeine and alcohol, which can worsen symptoms
- Addressing underlying causes, such as discontinuing medications that affect bladder function (like anticholinergics or certain antidepressants)
- Considering the use of medications like tamsulosin (0.4 mg daily) or finasteride (5 mg daily) to improve urine flow in men with prostate enlargement
- Pelvic floor physical therapy may be beneficial for women with pelvic floor dysfunction It is essential to seek medical attention if symptoms such as pain, fever, blood in urine, or inability to urinate occur, as these may indicate complications requiring immediate intervention. Additionally, a study from 2018 provides guidance on the surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia, which may be relevant to some cases of incomplete bladder emptying 1. Another study from 2020 discusses the appropriateness criteria for recurrent lower urinary tract infections in females, which may be related to incomplete bladder emptying in some cases 1. However, the most recent and highest quality study on this topic is from 2021, which should be prioritized when making treatment decisions 1.
From the Research
Incomplete Bladder Emptying
- Incomplete bladder emptying is a condition where the bladder is not fully emptied during urination, which can lead to various complications such as urinary tract infections and kidney damage 2, 3.
- The condition can be caused by various factors, including detrusor underactivity, neurogenic bladder, and bladder outlet obstruction (BOO) 2.
- Symptoms of incomplete bladder emptying include weak urinary stream, incomplete emptying, and urinary retention 2, 4.
Diagnosis and Management
- The diagnosis of incomplete bladder emptying involves a comprehensive evaluation of the patient's medical history, physical examination, and urodynamic studies 3.
- Management of incomplete bladder emptying depends on the underlying cause and may involve intermittent catheterization, pharmacotherapy, or surgery 2, 5, 6, 4.
- Intermittent catheterization is a commonly recommended procedure for patients with incomplete bladder emptying, but it can be associated with complications such as urinary tract infections 5.
Treatment Options
- Pharmacotherapy, such as 5 alpha-reductase inhibitors and alpha-adrenergic antagonists, can be effective in managing benign prostatic hyperplasia (BPH), a common cause of incomplete bladder emptying in older men 6, 4.
- Surgical options, such as transurethral resection of the prostate, may be considered in severe cases of BPH or other underlying conditions causing incomplete bladder emptying 6, 4.
- Further research is needed to develop effective treatments for incomplete bladder emptying and to improve patient outcomes 2, 3, 5.