A guide to double voiding and bladder-emptying techniques

By Rachel Nall, RN, BSN, CCRN  

Reviewed by Alana Biggers, MD, MPH

What is double voiding? | Additional bladder emptying techniques | Importance of bladder emptying | Treatment

Urinary frequency can mean that a person wakes up numerous times a night wanting to go to the restroom. Sometimes they may go only to feel they need to go again just minutes later.

These are just some of the problems associated with urinary frequency.

While the number of times a person may void urine can vary, a general rule is about 6 to 8 times a day. For someone who goes to the restroom more frequently than this, there are techniques they can try to ensure they can empty their bladder more fully.

One such example is double voiding. This can cut down on the feelings of urinary frequency that people may experience.

Importantly, a person should check with their doctor before attempting any bladder emptying techniques, as urinary frequency is sometimes due to a urinary tract infection. If there is an infection, this should be treated with antibiotics.

What is double voiding?

There are several approaches to improving bladder emptying. Double voiding in one of the most common.

This technique is especially effective for people who feel like their bladder is not empty, or who return quickly to the restroom after voiding.

The steps to double voiding are as follows:

• sitting comfortably on the toilet and leaning slightly forward
• resting the hands on the knees or thighs, which optimizes the position of the bladder for voiding
• urinating as normal, focusing on emptying the bladder as much as possible
• remaining on the toilet, waiting anywhere from 20 to 30 seconds
• leaning slightly further forward and urinating again

People may also benefit from rocking side to side as this can result in better bladder emptying. However, a person should not rock side to side if they cannot safely position themselves on the toilet.

There are additional variations on double voiding that people can use. One example is to stand up and walk around for 10 seconds before returning to the toilet. However, a person should never strain when they are passing urine as this can affect the pelvic floor muscles.

According to one study, people who used the double voiding technique had a lower incidence of bacteria in their urine than those who did not.

Additional techniques

There are other techniques besides double voiding that a person can use to empty the bladder and reduce urinary frequency.

The crede maneuver involves sitting on the toilet and leaning slightly forward before urinating. A person should place each hand above their pubic bone, press slightly inward toward their stomach, and begin urinating. They should continue to push toward the bladder as they void. This can help to increase the amount of urine expelled from the bladder.

Additional techniques include:

• Running water: Listening to running water can enhance a person's ability to empty the bladder.
• Bladder percussion: Tapping on the bladder with slight pressure can cause contractions that will help pass urine. A person should continue to tap for a few second even after the bladder seems fully emptied.
• Stimulation therapy: Touching certain areas of the body may stimulate the passing of urine. Stimulation methods can include pulling on the pubic hairs, massaging the lower stomach, or the inner thighs.
• Vibration therapy: Vibration therapy involves holding a vibrating device on the lower abdomen. The vibrations can stimulate the bladder and encourage emptying.

In addition to these techniques, a person should remember the importance of their environment when voiding. A quiet environment where someone doesn't feel rushed is very important to completely emptying the bladder.

Importance of bladder emptying

Incomplete bladder emptying not only adds to urinary frequency; it can also have other effects on the body. This is why techniques such as double voiding can be so important.

One of the complications associated with not fully emptying the bladder is that it becomes overstretched. When the bladder is stretched excessively, it may not "snap" back as effectively. This results in further difficulty with complete voiding.

Another complication is greater risk of urinary tract infections. When urine stays in the bladder too long, bacteria can build up. As a result, a person is at increased risk of a urinary tract infection.

Urinary tract infections are painful and can lead to scarring in the bladder as well as kidney damage if untreated. Whenever possible, preventing a urinary tract infection through double voiding ,or other techniques to reduce the incidence of urinary frequency, can help.

Treatment

In addition to techniques for enhancing bladder emptying, there are other treatments available to reduce the unwanted effects of incomplete bladder emptying.

Lifestyle changes

If someone is overweight, losing weight may help to reduce their incidence of urinary frequency. Avoiding consumption of too much fluid, especially before bed, can cut back on how often people wake up at night to go to the restroom.

Taking steps to prevent constipation whenever possible can also help. Examples of these include increasing the amount of fiber in the diet and exercising at least 30 minutes most days of the week. This stimulates the bowels and can help reduce constipation.

Drinking enough water is also important to prevent constipation, and people should not neglect drinking sufficiently in the hope that they will reduce the number of times they go to the restroom.

Exercises

Pelvic floor exercises to strengthen the muscles around the bladder can reduce the incidences of incontinence as well as improve bladder voiding. Examples of these exercises include Kegels.

Medications

Doctors can prescribe medications to help treat incomplete bladder voiding. Examples of these include:

• oxybutynin (Ditropan)
• tolterodine (Detrol)
• trospium (Sanctura)
• solifenacin (Vesicare)

Doctors can also perform botulinum toxin (BOTOX) injections to the bladder, to reduce how often bladder spasms occur, as well as encourage complete voiding.

Surgery and implantable devices

Incomplete bladder emptying as well as urinary incontinence can sometimes be addressed with implantable devices. Some of these provide electrical stimulation to strengthen bladder muscles that may have weakened.

Surgical approaches are also available to treat the bladder and surrounding pelvic organs. Examples include bladder neck suspension or bladder sling procedures. However, surgery should always be considered a last approach to urinary frequency treatment.


SOURCE: MEDICAL NEWS TODAY