Looking after your new bladder
A bladder reconstruction (neobladder) is an operation to make a new bladder. You might have a neobladder after surgery to remove your bladder (cystectomy).
When you have a neobladder, you continue to pass urine through your urethra as you did before. But it feels different to passing urine from a normal bladder. You will need to learn how to push the urine out.
The nurses and other team members will show you how to pass urine.
Learning to pass urine again
It takes time to learn to pass urine again. It will feel different to how it did before. Your nurse will explain how to do it.
When you want to pass urine, you hold your breath and push down into your tummy (abdomen). It’s a bit like pushing to open your bowels, but you use the muscles closer to the front of your tummy instead of those near your back passage. You might hear this called the Valsalva manoeuvre.
You wear a pad to begin with as you are likely to leak urine.
How often do I pass urine?
You don’t get the same sensation of needing a wee that you did before. You might feel a full sensation in your tummy when your bladder is full. But you usually need to rely on checking the clock and emptying your bladder at regular times.
At the start, you'll empty your new bladder more often – for example, every 2 or 3 hours. Your bladder needs to learn to stretch and fill with different amounts of urine. It can take a while for your bladder to stretch and to get to its full capacity.
Your specialist nurse will tell you how often to empty your bladder, and when you can increase the time between passing urine. It is important that you don’t over stretch your new bladder. So you should follow the instructions about how often to empty your bladder.
After about 3 to 6 months, your bladder should be able to hold about a pint or so of liquid.
Leaking urine (incontinence)
It’s not uncommon in the beginning to leak urine from your new bladder (be incontinent). This can be more of a problem at night when you’re asleep. At first, you will have to wake up once or twice at night to pass urine.
You should develop control quite quickly during the day. You might prefer to wear a pad for a while until you feel more confident.
It takes longer to be continent at night. You might leak urine at night for several months after surgery. But some people are dry much earlier. You will need to wear a pad at night.
Regular, pelvic floor exercises are the key to recovering continence.
Incontinence pads and sheets
There are different types of pads. You might be able to get some pads for free on the NHS, although this may depend on the service in your area. Some GP practices have a continence nurse you can see.
You might find it useful to get some incontinence sheets for your bed. This might not be necessary but could be reassuring.
Men could try a urinary sheath. The sheath looks a bit like a condom with a hole at the end. It fits on your penis and is connected to a tube and bag. Any leaked urine can drain into the bag. This might be particularly useful at night to help you sleep better.
'Just can’t wait' card or a radar key
You can get a card to show to staff in shops or pubs etc. It allows you to use their toilets, without them asking awkward questions. You can get the cards from Disability Rights UK or the Bladder and Bowel Community. They also have a map of all the public toilets in the UK.
You could get a key to disabled toilets if you need to access them quickly. You buy the RADAR key from Disability Rights UK. But this should only be used by people who need quick access to a disabled toilet due to a disability or medical condition.
Pelvic floor exercises
Your pelvic floor muscles help to control your bladder and prevent leakage. Pelvic floor exercises can help to strengthen these muscles. This helps you regain control of your bladder and can prevent incontinence.
Your specialist nurse or physiotherapist will teach you the exercises. They will tell you when to do the exercises and how often.
Self catheterisation
You might need to pass a tube (catheter) into your new bladder. If you need to do this, your specialist nurse will show you how to do it. This is called self catheterisation.
You might self catheterise if you aren’t fully emptying your bladder. It is important that your bladder is completely empty. If urine stays behind in your bladder it can cause problems with infection, leakage or bladder stones.
It probably won’t take very long for you to feel confident about passing the catheter. So try not to worry. Your nurses will support you. They will give you a prescription for the catheters. You can collect these from the chemist or they are delivered to your home.
Get support
Some organisations can give you advice and support. They might be able to arrange for you to meet other people with an internal urine pouch.
Meeting someone who has been through a similar experience might help you to cope. They know what is important to tell you. And they can answer your questions from first hand experience.
