Urination - difficulty with flow
DefinitionDifficulty starting or maintaining a urine stream is called urinary hesitancy.
Alternative NamesDelayed urination; Hesitancy; Difficulty initiating urination
ConsiderationsUrinary hesitancy affects people of all ages and occurs in both sexes. However, it is most common in older men with an enlarged prostate gland.Urinary hesitancy usually comes on slowly over time. You may not notice it until you are unable to urinate (urinary retention), and your bladder swells and becomes uncomfortable.Almost all older men have some trouble with: DribblingStarting urinationWeaker urine stream
Common CausesUrinary hesitancy can be caused by:Drugs (some cold remedies, some nasal decongestants, tricyclic antidepressants, and anticholinergic drugs used for incontinence)Enlarged prostate (benign prostatic hyperplasia)Inflammation or infection of the prostate gland (prostatitis)Nervous system disordersRecent surgery (postoperative retention)Scar tissue (stricture)Shy or bashful bladder syndrome (being unable to urinate when another person is in the room)Urinary tract infection
Home CareMonitor, record, and report your urination patterns to your doctor.Apply heat to your lower abdomen (below your belly button and above the pubic bone). This is where the bladder sits. The heat relaxes muscles and aids urination.Massage or place light pressure over your bladder to stimulate emptying.Drink plenty of fluids.For infections, you will need antibiotics from your doctor. Symptoms of a possible infection include burning or pain with urination, frequent urination, cloudy urine, and a sense of urgency (strong, sudden urge to urinate).Pay close attention to any medicines or supplements you take. See also:Enlarged prostate - after careProstatitis - bacterial - self-care
Call your health care provider ifCall your doctor for urinary hesitancy, dribbling, or a weak urine stream if you have not already been evaluated for these problems.Call your doctor right away if:You have a fever, vomiting, side or back pain, shaking chills, or are passing little urine for 1 to 2 daysYou have blood in your urine, cloudy urine, a frequent or urgent need to urinate, or a discharge from the penis or vaginaYou are unable to pass urine
What to expect at your health care provider's officeYour doctor will take your medical history and perform a physical examination, paying special attention to your pelvis, rectum, abdomen, and lower back.Medical history questions may include:How long have you had difficulty starting your urine flow?Did it come on over time or suddenly?Is it worse in the morning or at night?Is the force of your urine flow decreased?Do you have dribbling?Do you ever leak urine uncontrollably?Does anything help? Like heat or massage to the lower abdomen?Does anything make the hesitancy worse?Do you have other symptoms like fever, pain or burning when you urinate, cloudy or bloody urine, back or side pain?Do you have a history of bladder or kidney infection? Prostate enlargement or infection? Nervous system disorders?Have you had a recent injury, surgery, or procedure on the pelvis or bladder?What medications do you take, including over-the-counter drugs?Tests that may be performed include:Catheterization of the bladder to determine residual urine volume and to get urine for culture (a catheterized urine specimen)CystometrographyTransrectal ultrasound of the prostate (similar to a transvaginal ultrasound)Urethral swab for cultureUrinalysis and cultureVoiding cystourethrogramTreatment for urinary hesitancy depends on the cause. Often, medications such as alpha-blockers can relieve the symptoms. If you have a bacterial infection, your health care provider may prescribe antibiotics. You may need surgery to relieve a prostate obstruction (see TURP).
ReferencesGerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 3.Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116.Zeidel ML. Obstructive uropathy. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 125.