Feeling of incomplete bladder emptying

Editor: Petros Sountoulides, MD, PhD, FEBU Last updated: September 2018

Current Definition

"Complaint that the bladder does not feel empty after micturition" [1].

Older definitions

Abrams et al in 2002 described the feeling of incomplete bladder emptying as “a self-explanatory term for a feeling experienced by the individual after passing urine”. [2]

Vesical tenesmus is another term that had been used to describe the feeling of not being able to completely empty the bladder, despite possibly there being no urine present following urination. Although the term tenesmus when used unmodified usually refers to rectal tenesmus it has been used to describe the feeling of incomplete bladder emptying [3]

Perspectives and controversies

The feeling of incomplete bladder emptying, assessed by the first question of the International Prostate Symptom Score (IPSS), is a symptom experienced immediately after micturition, which has been shown to be indicative of lower quality of life for patients with LUTS [4] and associated with worsening of both voiding and storage symptoms [5] . There should be a clear distinction between the subjective “feeling or sensation of incomplete emptying” of the bladder and the actual fact of high residual urine measured on ultrasound after micturition. The feeling of incomplete bladder emptying is not always correlated to the finding of significant residual urine and can even be felt with an empty bladder. There has been however evidence of an association between high post-void residual (PVR) and the symptoms of slow stream, terminal dribble and feeling of incomplete emptying in women [6].

While the feeling of incomplete bladder emptying is justified within the clinical scenario of bladder outlet obstruction (BOO) with high PVRs, the sensation of not being able to fully empty the bladder in the absence of significant post-void residual (PVR) is subjective, of unclear aetiology and the subject of clinical studies [5,7]. Careful questioning should clarify whether the patient has a feeling immediately after voiding or the patient assumes the bladder is not empty because a short time after voiding there is a leak or urge.

The feeling of incomplete emptying is a symptom that can be attributed to a variety of diverse underlying conditions including BOO, underactive bladder and neurogenic voiding dysfunction. Careful history taking, focused physical examination and use of selected tests are helpful in order to understand the underlying pathophysiology and arrive at the correct diagnosis.

References

  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010 Jan;21(1):5-26.

  2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78.

  3. https://en.wikipedia.org/wiki/Vesical_tenesmus

  4. Fujimura T, Kume H, Nishimatsu H, Sugihara T, Nomiya A, Tsurumaki Y, Miyazaki H, Suzuki M, Fukuhara H, Enomoto Y, Homma Y. Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score. BJU Int. 2012 May;109(10):1512-6.

  5. Lee JY, Lee DH, Lee H, Bang WJ, Hah YS, Cho KS. Clinical implications of a feeling of incomplete emptying with little post-void residue in men with lower urinary tract symptoms. Neurourol Urodyn. 2014 Sep;33(7):1123-7.

  6. Özlülerden Y, Toktaş C, Zümrütbaş AE, Gülten MC, Başer A, Yapıcı O, et al. Can feeling of incomplete bladder emptying reflect significant postvoid residual urine? Is it reliable as a symptom solely?. Investig Clin Urol. 2018 Jan;59(1):38-43.

  7. Kobayashi M, Tokura Y, Kambara T, Nukui A, Kamai T.Feeling of incomplete emptying with little post-void residual in patients with lower urinary tract symptoms: Clinical implications and treatment outcomes. Low Urin Tract Symptoms. 2018 Feb 22. doi: 10.1111/luts.12217. [Epub ahead of print]

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