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CION Cancer Clinics
Learning to empty a neobladder, step by step | CION Cancer Clinics
You empty a neobladder by sitting down, relaxing the pelvic floor and pressing gently with the belly, at set times rather than when you feel the need. The pouch is made of bowel, so it does not squeeze and does not send an urge. This page explains the routine, how the timetable stretches over the first months, and the problems that are normal along the way. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- How do you actually empty a neobladder?
- The routine to follow each time you go
- How the timetable changes as the pouch stretches
- The problems almost everyone meets in the first months
- Four things families say about neobladder training, and what is true
- What this page cannot tell you
- Common questions about emptying a neobladder
The short answer
How do you actually empty a neobladder?
You empty a neobladder by the clock, not by feeling. You sit down, relax the muscles of the pelvic floor, and press gently downwards with the belly as if starting a bowel motion. The new bladder is made from a piece of your own bowel, so it cannot squeeze on its own and will not tell you when it is full.
Why it feels so different from before
Your old bladder had muscle in its wall and nerves that sent an urge to the brain. The neobladder has neither. Many people feel a vague fullness low in the belly, a little pressure, or nothing at all. That is why training is built around a timetable. In the first weeks you go whether you feel the need or not.
What the training is for
Two things. It teaches you a way of passing urine that works without a squeezing bladder, and it slowly stretches the pouch so it holds more. Both take months, and the stretching cannot be hurried by holding on too long too early.
Training starts only when the catheter comes out, a few weeks after the operation, and your surgeon confirms the join has healed.Every visit
The routine to follow each time you go
Sit down, every time
Men as well as women. Sitting lets the pelvic floor relax, and that is the muscle you are trying to let go of. Standing usually leaves urine behind.
Relax before you push
Breathe out slowly and let the muscles around the back passage go soft. Leaning forward with the forearms on the thighs helps many people.
Press gently with the belly
Bear down as if starting a bowel motion, but gently. The pressure inside the belly pushes the urine out. A flat hand pressed on the lower belly helps some people.
Wait, then go again
When the flow stops, stay seated a moment, then press again. Doing this twice, sometimes three times, empties the pouch properly. Your team calls this double voiding.
Note the time
Write down when you went. Your next visit is set from this one, not from when you next feel something.
Not sure whether this applies to you?
Ask an oncologistOver the months
How the timetable changes as the pouch stretches
Typical stages only. Your surgeon sets the actual timings, and they differ from one person to the next.
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The catheter comes out
A few weeks after surgery, once a scan or dye test shows the join between the pouch and the urethra has sealed. Until then the catheter is flushed regularly to clear mucus.
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The first weeks: very frequent visits
You empty every two to three hours through the day, and set an alarm to do the same at night. A small pouch that overfills will leak. Expect wet pads, and expect to be tired.
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Stretching the gap
Every few weeks, if you are staying dry and emptying well, your team asks you to add roughly half an hour between visits. Add time only when told to.
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Settling into a rhythm
By around three to six months most people go every four hours or so in the day and once or twice at night. Daytime control comes first. Night control takes longer, and for some it never fully arrives. Regular emptying then stays a lifelong habit, because an overfull pouch can stretch too far and strain the kidneys.
What to expect
The problems almost everyone meets in the first months
Mucus in the urine
The bowel lining keeps making mucus after it becomes a bladder. It shows as cloudy strands. If the flow keeps stopping, mucus is usually why.
What usually helps
- Steady fluids through the day
- Double voiding at every visit
- Flushing, if your team has taught you
Not emptying fully
A scan after you pass urine may show some left behind. A little is common early on. A lot, again and again, raises the chance of infection and stones, and some people are taught to pass a small catheter daily to finish the job.
Leaking between visits
Very common while the pouch is small, and worst at night. Pads are part of the plan for months, not a sign of failure. It improves as the pouch grows and the pelvic floor strengthens.
Infection, and the two things that cannot wait
Infections are more common with a bowel-lined bladder, and the usual burning may be muted. Cloudy, foul-smelling urine should be tested the same day. A fever with shivering, pain in one side of the back, or no urine at all with a swelling belly means hospital the same day.
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Commonly believed
Four things families say about neobladder training, and what is true
"Once the catheter is out, it works like a normal bladder."
It never works quite like the old one. There is no urge and no squeeze. What you get, with practice, is a bladder you control by habit and by the clock. It becomes automatic for most people, but it is learned, not given back.
"If he drinks less, he will leak less."
Cutting fluids makes the mucus thicker, the urine more concentrated and infection more likely. It does not stop night leaking, which comes from a small pouch and muscles relaxing in sleep. Drink steadily through the day and ease off only in the last hours before bed.
"Holding on longer will stretch it faster."
Holding on too early overfills a small pouch, which means leaking and sometimes urine backing up towards the kidneys. The stretching is set by your team in steps. Adding time before you are told to slows the whole process down.
"Needing a catheter means the neobladder has failed."
Some people, especially women, are taught to pass a catheter once or twice a day to empty fully. It takes a few minutes and becomes routine. It is one of the tools of living with a neobladder, and it is discussed before the operation for this reason.
Being straight with you
What this page cannot tell you
It cannot tell you how long your own training will take, or whether you will end up fully dry. That depends on the size of the pouch, the strength of your pelvic floor, your age, and how the nerves around the urethra came through the operation. Two people with the same surgery can have very different first years.
Who this routine is not written for
This page is about a neobladder joined to the urethra. If you have an ileal conduit with a bag on the belly, or a continent pouch emptied with a catheter through a small opening, the routine is different and this timetable does not apply. Your discharge summary says which one you have.
Where the support comes from
Neobladder training is not done from a leaflet alone. A continence or stoma nurse should see you in the first weeks, check how much is left after you pass urine, and adjust the timetable with you. Ask your centre who that person is before you leave hospital, and how to reach them.
If you are struggling and cannot reach your team, call the CION helpline. Someone will talk it through and help you get to the right nurse.Questions we are asked
Common questions about emptying a neobladder
Why do I have to sit down to pass urine? I am a man.
Because the neobladder empties when the pelvic floor relaxes and the belly presses, and both happen far more easily sitting than standing. Standing leaves urine behind, and urine left behind means more mucus, more infections and a pouch that stretches unevenly.
How do I know the pouch is empty if I cannot feel it?
You cannot be certain from feeling alone, which is why double voiding matters. In clinic, a bladder scan after you pass urine shows how much is left. If that number is high, your team may adjust your technique, add flushing, or teach you to pass a catheter.
How much should I be drinking?
Enough to keep the urine pale and the mucus thin, spread across the day rather than in large amounts at once. Your team will give you a target that suits your kidneys and heart. Ease off in the evening, but do not cut fluids in the day to reduce leaking.
I leak a little when I cough or lift. Is that normal?
In the first months, yes. The muscle around the urethra is doing the work the old bladder neck used to do, and it takes time to strengthen. Daily pelvic floor exercises are the main treatment. If it is not improving after several months, tell your surgeon, because there are further options.
What is the mucus, and will it ever stop?
The pouch is lined with bowel, and bowel makes mucus. It lessens over the first year as the lining adapts, but rarely disappears completely. Plenty of fluid keeps it thin. If it is thick, foul-smelling or coming with pain, have the urine tested, because that often means infection.
Can I flush the neobladder myself at home?
Only if your team has taught you and given you the sterile kit. Flushing means passing a small catheter and gently washing the pouch with salt water to clear mucus. Many people need it only in the early months. Do not attempt it from a video without being trained first.
My father finds the night alarm exhausting. Any way round it?
The night alarm is the part people find hardest, and it eases as the pouch grows. Meanwhile, a family member can share the night, absorbent pads soften a missed alarm, and the team can sometimes adjust the timings. Tell them honestly how it is going.
Will I ever get the feeling of needing to go back?
Most people develop some sense of fullness over time, usually a pressure or dull ache low in the belly rather than the sharp urge they remember. It is not reliable enough to replace the clock, especially at night. Treat it as a reminder that sits alongside the timetable, not instead of it.
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Sources
- Macmillan Cancer Support — Bladder reconstruction
- Cancer Research UK — Treatment for bladder cancer
- American Cancer Society — Bladder cancer surgery
- NHS — Bladder cancer: treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Neobladder: How It WorksWhat the pouch is made of and why it behaves this wayNight-Time Leakage With a NeobladderThe part of training most people find hardestWho Is Not Suitable for a Neobladder?Why some people are steered to a conduit insteadUrine Infections After Urinary DiversionWhy infections are more common and what to watch forRadical Cystectomy and Urinary DiversionEvery page on bladder removal and what replaces it
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