Is there urine left in the bladder even after you finish urinating? (Post-Void Residual Urine Test) Let's find out exactly what it is!

Do you sometimes feel like you haven't completely emptied your bladder after urinating ? Or do you feel like you need to urinate several times a day, maybe even more often than you think? If you have these minor discomforts, don't think that it's anything to worry about. Sometimes, even when you think you've finished urinating , there may be some urine left in your bladder. We doctors call this 'Post-Void Residual' (PVR) . Simply put, it means "urine left after urination ."

Why is this 'post-void residual' (PVR) test done?

Okay, now you're probably thinking, "So why do we do this PVR test?" The main reason for doing this is to find out exactly when your bladder is emptying completely, or if there's urine left over. This urine retention is called 'urinary retention' . While it's normal to have a small amount of urine left over, if there's a lot of urine left over, it could be a sign of some health problem.

Your doctor may recommend a PVR test if you have any of these symptoms:

• Frequent urination : If you need to urinate many times a day, perhaps once an hour.
• Difficulty controlling urine (incontinence): When you have an involuntary loss of urine while standing.
• Frequent Urinary Tract Infections (UTIs): If you get UTIs every few months or more often.
• A feeling of heaviness in the stomach and a feeling that the bladder has not emptied even after urinating .
• If you have been diagnosed with bladder stones.

Imagine, your friend, let's call him Supun. Supun has been having to urinate frequently these days. He has to get up two or three times a night. He says that after he urinates , he feels a fullness in his stomach. When he goes to see a doctor, the doctor tells him to do this PVR test. That's when this test becomes important.

How is this PVR test done?

Okay, now let's see how to measure the amount of urine remaining in the bladder, or PVR. There are two main methods used for this.

1. Bladder Catheterization

This is one way. Doctors call it 'bladder catheterization' . Here's what happens:

You first go to the toilet and empty your bladder as much as possible. Then, either a doctor or a trained nurse will insert a very thin, flexible tube – we call this a 'catheter'.– It is inserted very carefully into your bladder along your urethra. Once inserted, all the urine remaining in the bladder is removed and the amount is measured. This may seem a little awkward, but this is done very carefully.

2. Ultrasound examination

The other main method is an ultrasound test. You may have heard of this. This uses sound waves to look inside the bladder. There are also two methods for this:

• Bladder Scan: In this, the scan is done on your abdomen, where your bladder is. A doctor places a small device (we call it a 'probe' ) on your abdomen and uses sound waves to take a picture of your bladder and see how much urine is left.
• Transvaginal Ultrasound: This is a type of scan done on women. Here, a 'probe' is inserted through the vagina to take pictures of the bladder. This method can sometimes produce clearer pictures.

The doctor will choose the most appropriate of these two methods based on your condition.

How should I prepare for this test?

Most of the time, there is no special preparation required for this PVR test. You can eat and drink as usual. However, sometimes your doctor may tell you to drink a little more water a few hours before the test and to keep your bladder slightly full. Therefore, it is best to ask your doctor or the nursing staff before the test if there are any special instructions you need to follow.

What exactly happens during 'Bladder Catheterization'?

Let's say you choose to measure your PVR by bladder catheterization. Then something like this happens:

1. Emptying the bladder: First, you will be sent to the toilet and asked to empty your bladder as thoroughly and completely as possible.

2. Preparation: Next, you will be asked to lie down on an examination table, bend your knees, and spread your legs to the sides. This will allow for a better view of your urethra.

3. Cleaning and Numbing: Next, the doctor or nurse will thoroughly clean your urethra and the area around it. Then, they will apply a small amount of local anesthetic to numb the area. This will help you feel less pain.

4. Inserting the catheter: Now, the thin tube called the 'catheter' is carefully inserted through your urethra into your bladder.

5. Urine removal and measurement: All remaining urine in the bladder is removed through the catheter and the amount is accurately measured.

6. Removing the catheter: After collecting the urine, the tube is carefully removed again.

It will only take a few minutes for all of this to be over.

What happens during an ultrasound PVR test?

Now let's see what happens when PVR is measured with an ultrasound. This is a little different than catheterization.

1. Emptying the bladder: In this case, you will first be sent to the toilet and asked to empty your bladder as much as possible.

2. Preparation: Next, you will be made to lie down on an examination bed.

3. Gel application: For a bladder scan, a special gel is applied to your abdomen, where your bladder is. This gel helps to create a good connection between the probe and your skin. For a transvaginal ultrasound, the gel is applied to the probe.

4. Scanning: Next, the doctor places the ultrasound probe either on your abdomen (for a bladder scan) or inside your vagina (for a transvaginal ultrasound) to get the best possible images of your bladder. You can view these images on a nearby monitor.

5. Finishing: After taking the necessary pictures of the bladder, the probe is removed. You can then wipe away any excess gel.

This too will be over in a few minutes.

What happens after the PVR test?

This PVR test is usually not a very complicated procedure. We call this an 'outpatient procedure' . This means that as soon as the test is done, you can go home or go back to your normal work. You can resume your daily activities as usual.

However, if you have had a bladder catheterization , as the numbing medication wears off, you may feel a little discomfort or burning in your urethra for a few days. The best thing to do for this is to drink more water and urinate several times a day. This will help to reduce the discomfort to a great extent.

Are there any risks with this PVR test?

There are no major risks involved in an ultrasound test. It is very safe.

However, bladder catheterization , although very rare, can carry a few minor risks. These are:

• There is a small chance of developing a urinary tract infection (UTI). This is because something foreign is introduced into the urethra. However, this is very rare. Sometimes your doctor may give you a medicine called ' antibiotics ' to reduce this risk.
• You may have some blood in your urine (hematuria). This usually resolves within a day or two.
• Very rarely, it can be something like a small injury to the urethra or bladder.

But, I repeat, these risks are very small. Doctors perform this test with great experience and care. So don't be unnecessarily afraid. If you have any doubts, talk to your doctor.

What should the 'post-void residual' (PVR) value be normally?

Okay, now let's look at the results of this PVR test. The amount of urine remaining in your bladder is usually measured in milliliters (mL).

• For a healthy adult, it is often considered normal for less than 50 milliliters (50 mL) of urine to remain in the bladder after urination .
• If it's between 50 and 100 milliliters (50 mL - 100 mL), it can sometimes be normal, or it may be something that needs further investigation.
• If more than 100 milliliters (100 mL) is left, it can usually be considered 'urinary retention'.

But remember this: Your doctor will determine exactly what is 'normal' and 'abnormal' PVR for you. It depends on many factors, including your age, your health, and the medications you take. So, once your results are in, it's important to talk to your doctor about them and understand what they mean.

How long does it take to know the results of the PVR test?

This is something you should know. In most cases, the results of a PVR test are available immediately, almost immediately after the test is done. An ultrasound can tell you right away. A catheterization can also tell you the amount of blood flow measured. However, it is best to ask your doctor or nurse when you will be able to discuss the results.

Why does this bladder hold too much urine (High PVR Volume)?

There are several reasons why too much urine can remain in the bladder, or a high PVR. Here are some of the main causes of this 'urinary retention' condition:

• A blockage somewhere in your urinary system: For example, something like a bladder tumor, a urinary stone, or a blockage in the urethra.
• Enlarged prostate (BPH): This is common in men as they age. When the prostate gland enlarges, it can compress the urethra, making it difficult for urine to flow out.
• As a side effect of some medications: Some painkillers, antihistamines, and some medications for mental illness can affect bladder function.
• Narrowed urethra or urethral stricture: If the urethra has become narrowed, either due to an infection or injury.
• Nervous system problems:Neurological diseases such as diabetes mellitus, spinal cord injuries, Parkinson's disease, and multiple sclerosis can damage the nerves that control bladder sensation and function. This condition is called a neurogenic bladder .
• Weakness of the bladder muscles.
• Constipation: Severe constipation can also put pressure on the bladder and prevent urine from flowing properly.

How to treat bladder retention?

If your PVR is found to be high, meaning that more urine is left in the bladder, your doctor will next look at the underlying cause , as treatment will be determined based on that cause.

• If the cause is a side effect of a medication, the medication can be changed or the dosage can be reduced.
• If the prostate gland is enlarged, it may be treated with medication or possibly minor surgery.
• If there is a blockage in the urinary tract, surgery or another procedure may be performed to remove it.
• If it's a nerve problem, medications or other methods to help you empty your bladder may be used while you're treating it . Some people may be recommended to practice timed voiding or use a catheter.

The most important thing is that your doctor will talk to you about this in detail, explain what your options are, and whether any further tests are needed. So, don't be afraid to ask your questions.

When should I see a doctor?

This is also very important.

If you suddenly find yourself unable to urinate at all, meaning your urine is completely blocked, it is an emergency. You should go to a hospital's emergency department (ETU) immediately. Don't delay.

Additionally, if you have one or more of these symptoms, be sure to see your family doctor or a urologist:

• If you have pain or swelling in the lower abdomen.
• If you have pain or burning when urinating .
• If you have a fever.
• If the urine is dark in color or has a bad odor.
• If there is blood in the urine.
• I need to urinate frequently, but only a little at a time.
• If your bladder still feels full after you finish urinating .

Don't ignore these symptoms. Seeking medical advice early can prevent the condition from getting worse.

Finally, things to remember (Take-Home Message)

So, finally, if you think you have symptoms of urinary retention, that is, urine left in the bladder, your doctor may ask you to do this 'post-void residual' (PVR) test. While it's normal to have a small amount of urine left in your bladder sometimes, having too much can damage your bladder, affect your kidneys, and lead to frequent infections. Not only that, but it can also be a sign of an underlying condition that needs to be treated.

If your PVR is high, your doctor will determine the cause and recommend the best treatment for you. If you have any questions or concerns about this test or your results, don't hesitate to ask your doctor. You have every right to be informed about your health. Stay healthy!

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