Incomplete emptying

Welcome to the best place in the world for women managing these conditions themselves. You will find great fellowship here.

I think your doctor needs to do some more reading about prolapses. Inability to fully empty either bowel or bladder *is* one of the normal symptoms of pelvic organ prolapse (POP). I have read it in several places, and was tested for it myself by ultrasound only a couple of months ago. I have significant prolapses of bladder, uterus and rectum. In the past I have had lots of urinary tract infections. No longer. The figure for retained urine in my test was within satisfactory range. I do have to consciously fully empty my bladder, though it is second nature now.

Different women have different techniques. They are all based on tipping the bladder forward so the urethra is at a lower point than the lowest point of the bladder when urinating, so the bladder literally drains itself. There are several ways you can do this.

While sitting on the toilet every time, straddle the bowl by moving your feet back towards the cistern, semi squatting and putting your hands out front on the floor or your elbows on your knees. Be prepared for spills till you get the positioning accurate. <:-o>

Another way is to urinate on hands and knees under the shower once a day,

or on all fours once a day with a basin between your legs, not on carpet (can't imagine why?).

Other members will probably chime in with their suggestions.

You can see this last one illustrated, and illustrations of what happens with bladder emptying when you have POP, in Christine Kent's book, Saving the Whole Woman. Get the second edition, with the blue cover. It is much better than the first edition. This book has all you need to understand and know to manage these uncomfortable, and sometimes limiting conditions, in a way that will probably allow you to get back to most, if not all your previous activities. Some women have incredible success with these techniques. The basics are on www.wholewoman.com , but the book is my POP bible, with great illustrations. This probably sounds like an advertisement. It is not an ad. It is just a very, very useful book, that many of us would swear by.

If the doctor said you have a rectocele, you probably have, in addition to the cystocele/urethrocele. They often move together, and sometimes the uterus is involved as well, even if you are not aware of it. The cystocele may be evident when your rectum is empty. The rectocele may show when your bladder is empty. You might even find that your cervix is a little lower when both bladder and rectum are empty. I have found my organs to be much more stable now all three have descended. They all hold hands and keep themselves together and well inside the introitus as long as I keep my posture well, watch my diet etc. :-)

No doubt the doctor examined you lying down. They usually do. They don't seem to realise that no woman really feels their cystocele or uterine prolapse when lying down, and bearing down on the examination table doesn't approximate standing very well. They just don't get it. Nothing personal about the doctor. They are trained on illustrations and cadavers, and get to know the orientation and positions of organs, bones and muscles in a lying down position. Many of them probably wouldn't be able to find their way around the insides of a standing woman by feel, but some of them can, and some of them will examine you standing if you ask. I think they just don't like kneeling in front of a woman (brain problem, very freudian!).

Hope this is helpful.

Louise

LOL

I personally think they just don't like looking up at a woman when she is standing and they are kneeling at her feet! Seriously, even if she is paying!!

L

Hi Cynthia and Louise --

I've experimented with another way to help the bladder empty completely and it seems to help.

While standing in the shower, pee out as much as you can. Wait a few seconds to be sure that's all there is. Then gently insert your two middle fingers into your vagina. Gently and slowly press upward and toward the front wall of the vagina, lifting the bladder and pressing it gently up and forward. Hold it there and wait several seconds and you will get the familiar urge, then the here-it-comes feeling, and then another significant amount of urine will flow out.

This does involve peeing on your hand. However, you're in the shower with soap close by and that's not a big deal once you get over the idea. Most of us have had pee on our hands before!

I'd be interested to know whether this works for anyone else. I should say that I don't have the sensation of not having emptied my bladder after I've urinated. I thought it was all out. But I learned from this forum that incomplete emptying can become a problem and so thought I would try to make SURE it was all out. Maybe this will help head off problems for me, and I would be very glad to hear that it works for someone else.

Ellen

I had a transvaginal ultrasound a few months ago because I had a new doctor who was finding out herself the degree of prolapse etc and investigating my kidneys, bladder etc as part of a blood pressure/heart investigation which turned out to be all clear.

I have probably third degree cystocele, rectocele and/or uterine prolapse, depending on what is where on the day, and how hard I bear down when examined.

We did discuss the 'on the back with the butt on a pillow' posture the radiographer requested I assume, so that she could assess my prolapses, as being exactly the opposite position to the position where my prolapses are most evident, and she did agree that it didn't make a lot of sense, but that is the way they do them.

I had one ultrasound scan with a full bladder, then was sent off to the toilet to empty my bladder, and rescanned. It was estimated that I was able to empty all except 15ml of bladder, which was an acceptable result, just by sitting forward on the toilet with my feet well apart and tipping my bladder forward, emptying, half standing then sitting and emptying again. I can empty better now than I could when I first went to the gyn 3 years ago!

It is really just a matter of using gravity to help, rather than to hinder the process. It really doesn't matter how you do it, whether on all fours, or straddling the bowl, leaning over under the shower, or taking a pee, pulling up your knickers, walking three times around the cubicle and doing the whole process again (which is MeMyself and I's neat trick). It is just a matter of having the bladder tipped so that the plughole is at the bottom of the bladder, where it can drain, and the urethra is emptying downhill, so it can drain.

It is not rocket surgery, and I cannot see for the life of me why these health professionals keep tipping women upside down to get a better picture of what happens when they are right side up! It really is something out of Alice Through the Looking Glass.

I am sick to death of doctors reading that I have prolapses and saying gleefully, "Well, let's find out exactly what is happening in there." Next thing I know I am doing the stranded cockroach position *again* and have a doctor pontificating about how I could learn to strengthen my pelvic floor and it is possible to have surgical repairs done, dear". Then when I say, "No thanks, I am managing it myself." and they say, "How?" and I tell them and their eyes glaze over, and they look bemused and offer me pelvic floor training again!!! AArrrggghhhh!! NO MORE, THANKYOU.

I really think you are right Cynthia. They really just don't like being below a woman. They could just as easily have the woman squat on a platform so they don't have to get down on hands and knees, but no, they would rather have the patient in a vulnerable position than be there themselves. I still think a lot of it is about power and authority, which I think is a pretty poor way of looking at health care.

Yes, next time a doctor insists on taking a peek for assessment purposes I will suggest they kneel to examine me standing or squatting. Doctor no kneely, doctor no examiney. I think I know more about my girl's bits now than they would ever want to know, so they can just ask me instead!

Cheers

Louise

I would try NOT to drink anything after 6 p.m. especially anything with caffeine in it or alcohol. It definitely makes a huge difference for me. If there's nothing in there, you probably won't have to go.

Hi Mom30

Don't take this personally, but not drinking after 6pm is probably not good for your kidneys and overall wellbeing, and especially for any breatfeeding Mums out there. 6pm until 7am without fluids is a long time to go on a regular basis, though I would think it probably doesn't matter occasionally.

Many ageing people (and I don't know Cynthia's age) end up not drinking after an evening meal and hardly drinking anything over 24 hours because they think keeping the bladder empty will solve their continence problems, and they end up chronically deydrated, with struggling kidneys, and deteriorating health. Also it means that the urine will be more concentrated. That probably means more stuff for bacteria to feed on and the bladder doesn't get flushed out with a 'strong whoosh' of diluted urine when you pee, so UTI's are more of a risk.

All the continence people I have ever spoken with say to drink normally and learn to hold on to urine for a while; and learn to empty properly, even if it takes a few tries to do it, with your bladder. Act on bowel impulses immediately to keep your bowel healthy and regular.

Hi Cynthia

I think you may have asked about incomplete emptying a specific situation. If you don't mind me asking, what exactly is the problem with your bladder at night? I am not trained formally at all in continence education but I have had some different continence issues at different times of my life, so my ears are always open for different situations and solutions. If you don't feel comfortable about sharing this info on the forums I am happy for you to email me. Just click on my username, then the Contact tab and an email form comes up. For that matter, you can email any Member who has email enabled if you want to ask a question or comment, one to one.

As an aside, my daughter had major continence issues up to the age of six or seven, which were cured almost completely with chiropractic over only a few weeks, with monthly followup for about a year. The chiropractor was gob-smacked at the success, cos he wasn't really expecting anything as dramatic. DD did end up having other health issues which exacerbated it, but chiropractic did have a major beneficial effect. I think it was because the nerves that transmit the sensations to the bowel and bladder were perhaps squashed, so the signals weren't getting through. I am still very cautious of chiropractors though, as I have had a very nasty experience with one, and I don't think any physical health therapy in an otherwise healthy person should need monthly treatments for life, which adds up financially!. I think we can do so much more for ourselves and get the same benefits. This is more what Wholewoman is about.

Cheers

Louise

Hi Cynthia

Yeah, I get the mixed signals too. I think it is because my organs are so mobile that they literally put pressure on each other, particularly intestines on the bladder. Once the bowel contents move, it is pee-pee-pee! Just like magic.

Nighttime is a pain cos all you want to do after a midnight pee is go back to bed, not wander around the bathroom doing half a yoga routine in order to empty your bladder. when you go back to be after a pee, is there actually any urine left in your bladder?

Do you know about the pressure point just under your nose at the top of the depression above your lip (cupid's bow?). My Continence nurse told me it is a pressure point that stops bladder contraction. You might find it useful to press it when you get back into bed? Then your bladder might let you sleep. She advises lots of women at menopause and beyond, that it can give you a couple of minutes' grace if you are caught away from a toilet with your bladder wanting to empty. I tried it and it does seem to work as long as you do it soon enough.

Re 'straining', try using the Search box. We have discussed this in glorious technicolour detail in the last twelve months. MeMyselfandI advocates leaning to the right instead of straining. This resonates with a yoga pose for compressing the abdomen too, right side then left. She might pop up with suggestions, as may other women. I think the problem with straining (not just sitting there with a little positive pressure) is that it is not productive. It just puts strain on the fascia without emptying, and risks further damage.

I think your Mom is right! No cissies here!

Cheers

Louise

hmmm i had this on and off for 10 years, horrid.

What i discovered was the feeling was actually my bladder and or urethra in spasm..if you check inside you may find that your urethra feels hard instead of squashy.

have you been checked for utis? even if it shows up -ve its often they that will not show up in the usual agar plate test but would with a broth culture..its a good precaution to rule out utis before presuming it is the prolapse causing these woes.

what i found worked short term was to take a benadryl, i took it because i needed sleeeeeeeeep but it had the knock on effect of stopping the spasming. I hate taking anything like this so found some natural anti histamines have helped.

the other thing was to have a biiiiiiiiiiiiiig glass of water before bed, i'm surmising that the small amount of urine that is left should not leave you feeling like you still need to go, its just that everything is unhappy and irritated down there. now if you keep drinking, instead of that little bit of urine being allowed to stay and become stagnant, it will be contantly diluted and flushed out. A drink before bed should mean if you get up in the night you'd pass more dilute urine rather than a small stagnant bit that irritated everything on it way out and starts up a cycle of feeling like you constantly need to go...

I found the best natural combo to be vitamin c in 3 grams or more, grapeseed extract or pycnogenol - this is supposed to work synergistically with vit c to increase its benefits and it also promotes collagen building and a good omega oil (like udos)

that what all my kids do- I figured it was just normal. Although the baby has a hard time holding it (the pee) if he has a full colon- but still he goes poop then pee just like the others.
I have been thinking about this night time problem. I cannot imagine you are getting good rest if you are up every two hours. I wonder what you can do. I am interested to see if the BIIIGGGG glass of water before bed works- seems like backwards advice but I think it might make sense anyway.
I bet if you filled a bath with warm water and go in an relaxed a while and then peed in the tub (gasp) you could probably get totally empty and go right back to sleep- maybe put some sea salt in or essential oils for increased relaxation- I don't know- for me even if I pee right before I get in I find the warm water just begs me to pee in it :)