Voiding dysfunction

We have written this information to tell you about why it can be difficult to pass urine. This condition is called voiding dysfunction.

What is voiding dysfunction

Voiding dysfunction is a difficulty with passing urine, incomplete bladder empty or not experiencing the sensation to empty the bladder regularly.

Urine passes from the kidneys through the ureters into the bladder. The bladder constantly fills, storing urine until we feel a need to empty.

The urinary system

We can normally store between 300 to 600mls of urine in our bladder and pass urine between five and eight times a day. It is advised to drink between 1.5 and 2 litres of fluid a day as poor intake of fluid can affect the bladder storage and empty.

Symptoms of your voiding dysfunction

• Urgency to get to the toilet.
• Needing to go to the toilet more often.
• Hesitancy to start the flow of urine.
• Poor or interrupted flow of urine.
• Feeling like you have not emptied your bladder fully.
• Straining to pass urine.
• Leakage after passing urine.
• Bladder discomfort

Reasons for having difficulty with passing urine

There may be many reasons why you may be having difficulty with passing urine, these include:

Recurrent UTIs

Recurrent urinary tract infections (UTIs). This is defined as three episodes of bladder infection (detected by a positive urine test) in 12 months. This would need to be checked by a bladder specialist and antibiotics can help. If you are of menopausal age you may also benefit from long term vaginal oestrogens such as cream or pessaries. Oestrogens decline during the menopause, causing thinning of the lining of the bladder and altering the pH increasing the risk of infection and leading to the urge to urinate more frequently. Some women with recurrent UTIs may wish to try cranberry products if they are not pregnant, although the evidence of benefit is uncertain. The advice later in this leaflet can help manage this problem.

Acute urinary retention

If you cannot pass urine this is called bladder retention. It is the sudden and often painful inability to pass urine despite having a full bladder.  It is considered an emergency and you need to be examined by a healthcare professional as soon as possible. It causes severe pain and may result in damage to the kidneys or bladder. The condition is treated by inserting a catheter into your bladder to drain the urine. This may be a “one off” or you may need the catheter to stay in for a period of time. Medication may help relax the urethral opening or stimulate the bladder muscle.

Chronic urinary retention

Chronic urinary retention is a persistent painless holding of a significant amount of urine within the bladder after emptying, this is often caused by an obstruction, inflammation or infection. Tests may be needed such as testing the urine or a scan. Your health care professional may need to teach you how to perform intermittent self-catheterisation (ISC) to manage this problem.

Alteration of the support of the pelvic organs

If the pelvic organs such as the bladder are not fully supported a pelvic organ prolapse may occur. This may cause a pouch in the bladder where urine is stored, and it can be difficult to empty your bladder completely.

Pelvic floor muscle exercises may help support the pelvic organs.

Difficulty with relaxing the pelvic floor muscles

The pelvic floor muscles are the supportive muscles that fill the lower part of the pelvis and surround the bladder opening. These muscles tighten to control the bladder, preventing leakage and relax to pass urine. Sometimes these muscles find it hard to relax and urine is retained, or you may have signs of difficulty with passing urine.

The pelvic floor muscles

Advice to manage difficulty with emptying the bladder

If you have difficulty “letting go” or relaxing your pelvic floor muscles and feel you are not fully emptying your bladder or you need to strain to “push the urine out” the advice below may be beneficial. The techniques can enable you to start your flow and pass urine in a relaxed manner, helping decrease urgency and frequency, completely empty the bladder, stop leakage and minimise infections.

Generally

• Drink regularly during the day, aiming for 1.5 to 2 litres of fluid per day.
• Ensure you empty your bowels regularly. Your stools should be soft and easy to pass. Regular meals, with a healthy diet including fibre and vegetables helps. If you have a problem emptying your bowels talk to your doctor or nurse.
• Go to the toilet when your bladder feels full, not “just in case”
• Go to the toilet every 3-4 hours. Don’t hold your urine for long periods.
• Allow yourself time to pass urine and empty your bladder.
• Sit on the toilet, don’t hover above it.
• It is helpful to sit down on the toilet seat with the feet supported and slightly apart as this may help the pelvic floor to relax. Rest your hands on your knees and lean forward, letting your tummy relax. Sometimes resting the feet on a small footstool may help.

Difficulty with starting / maintaining flow

• Stay as relaxed as possible and avoid straining
• Ensure you let go of your pelvic floor, relax and let your tummy soften.
• If it is difficult to relax, try a gentle squeeze of the pelvic floor, from the anus upwards and forwards then, hold for a count of three and then let it drop.
• Take some relaxed breaths, in through your nose for a count of four then out through your mouth for a count of seven. Sometimes singing can help.
• Tapping just above the pubic bone can help.

Incomplete empty / dribbling

• When you think you have finished emptying your bladder, it can be helpful to sit and wait for a few minutes. You may manage to pass some more urine.
• Leaning forwards during and after passing urine or rocking sideways or applying gentle pressure with your hand over your bladder can also help to empty your bladder.
• After you have finished passing urine stand up and sit down or move around for a few minutes. Then go back to the toilet and try to pass some more urine. This is called double voiding.

Contact us

If you continue to experience difficulty passing urine, contact your physiotherapist, continence advisor or specialist nurse for further help.

Additional information

If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS Choices website at www.nhs.uk 

If you would like to find accessibility information for our hospitals, please visit www.disabledgo.com

Patient Advice and Liaison Service (PALS) can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received 0800 032 0202

Review date: March 2025