Urinary Hesitancy

What is urinary hesitancy?

Urinary hesitancy is when you have difficulty urinating (peeing) — you may have trouble starting to pee or it may be challenging to maintain a steady flow. You may even stop peeing while you still need to go.

Anybody can have urinary hesitancy. But you may be more likely to have it if you’re assigned male at birth (AMAB).

What does hesitancy mean in medical terms?

In medical terms, “hesitancy” means you have trouble starting or maintaining urine flow while urinating.

What are the symptoms of urinary hesitancy?

The main symptoms of urinary hesitancy are difficulty starting to pee or stopping before you completely empty your bladder. Other symptoms may include:

• Feeling like you have to pee but nothing comes out.
• Straining or pushing to pee.
• Slow or weak pee stream.
• Dribbling.

Urinary hesitancy may also cause urinary retention or the inability to pee. Common urinary retention symptoms include:

• Lower abdominal pain.
• Abdominal swelling.
• Leaking pee (urinary incontinence).

What can cause urinary hesitancy?

The most common cause of urinary hesitancy is benign prostatic hyperplasia (BPH), which causes your prostate to grow larger than normal. BPH affects most people AMAB as they reach their 60s and older.

Other common causes include:

• Urinary tract infections (UTIs), or bladder infections.
• An infection in your prostate (prostatitis).
• Scarring in your urethra (urethral stricture).
• Severe constipation.
• Certain medications, which may include tricyclic antidepressants, urinary incontinence medications, and cold and allergy medications.
• Inability to relax your pelvic floor muscles to pee (pelvic floor dysfunction).
• Nervous system conditions that affect how well your brain sends signals to your bladder, including stroke, multiple sclerosis (MS) or diabetes-related neuropathy.
• The muscles in your pelvis being too weak to support your pelvic organs (pelvic organ prolapse).

Who does urinary hesitancy affect?

Anyone at any age can have urinary hesitancy. But it’s more common in people AMAB who are 60 or older and have an enlarged prostate.

How is urinary hesitancy diagnosed?

A primary care physician (PCP) can help diagnose urinary hesitancy. They’ll ask about your symptoms, review your health history and perform a physical exam. They might ask you:

• How long have you had trouble peeing?
• Is your pee stream weaker than usual?
• Did your symptoms develop over time or did they appear suddenly?
• Are you taking any over-the-counter medications to help relieve your symptoms?
• Do you notice your symptoms worsen after certain activities or eating or drinking certain foods or beverages?

They may also order tests to help them confirm a urinary hesitancy diagnosis.

What tests will be done to diagnose urinary hesitancy?

A healthcare provider may order urodynamic tests to help diagnose the cause of your urinary hesitancy. This series of tests helps measure:

• How much you pee.
• The strength and speed of your pee stream.
• Pressure on your bladder.

Other tests a provider may order include:

• Imaging tests, such as an ultrasound or computed tomography (CT) scan, to see how your bladder fills with and empties pee and to measure the size of your prostate. They may also use a special camera to look through your urethra into your bladder (cystoscopy).
• A digital rectal exam to check the size of your prostate.
• A urine test (urinalysis) to look at your pee’s microscopic, visual and chemical elements.
• A urine culture to look for signs of bacterial infection.

How do you treat urinary hesitancy?

Fixing a slow urine flow depends on the cause and whether you have any other conditions. A healthcare provider may recommend:

• Bladder retraining (timed voiding).
• Pelvic floor physical therapy.
• Medications.
• Surgery.
• Sacral nerve stimulation (sacral neuromodulation).

Bladder retraining (timed voiding)

You retrain your bladder muscles by going to the bathroom at set times (usually every two hours) to prevent your bladder from getting too full. You do these even if you don’t have to pee.

Pelvic floor physical therapy

Exercises help relax your pelvic floor muscles.

Medications

A provider may prescribe medicines to stop the growth of or shrink your prostate (dutasteride or finasteride) or relax the muscles in your bladder and prostate (alpha-blockers). They may also prescribe antibiotics to treat an infection.

Surgery

Urethral dilation or urethral reconstruction can help treat a narrow urethra. There are many types of procedures to remove excess prostate tissue, from more simple procedures in the office and surgeries using electrical or laser energy to prostatectomy to remove part of or your entire prostate to help relieve BPH symptoms. Surgery can also treat pelvic organ prolapse by putting your organs back in place and supporting them so they don’t drop again.

Sacral nerve stimulation (sacral neuromodulation)

A provider implants a small device (neurotransmitter) near your upper buttock (butt) area. The neurotransmitter sends mild electrical impulses near your sacral nerve to stimulate bladder muscles.

How do you treat urinary hesitancy at home?

In some cases, you may be able to treat urinary hesitancy with some home remedies, including:

• Heat. Heat can help your pelvic floor muscles relax, making it easier to pee. Taking a hot shower or bath or placing a heating pad or hot water bottle can relax these muscles.
• Massage. Using your hand to gently massage or apply light pressure to your abdomen near your bladder while peeing can help increase the strength and speed of your pee stream.
• Stool softeners or laxatives. Diet and medications can help regulate bowel function if you’re having trouble pooping. This can help your bladder function better.

You should only try to treat urinary hesitancy with home remedies if a provider says it’s safe.

A provider may also recommend keeping a bladder diary. In your bladder diary, keep track of:

• How much fluid you drink.
• How much you pee.
• The strength of your stream.
• How long it takes to pee.
• How often you pee.
• Any other symptoms.

How soon after treatment will I feel better?

It depends on what’s causing urinary hesitancy and the recommended treatment:

• Pelvic floor physical therapy may take several weeks before you start to see results.
• Medications that relax your muscles may take a few hours to take effect.
• Sacral nerve stimulation may take a few weeks after a provider implants the neurostimulator.
• It may take a few months to fully recover after surgery.

Can urinary hesitancy be prevented?

You can’t prevent every cause of urinary hesitancy. But maintaining good bladder habits and preventing constipation may help. You should pee every few hours and ensure you don’t hold your pee too long. You should also have a goal of a good, soft poop (bowel movement) every day.

What can I expect if I have urinary hesitancy?

If a healthcare provider diagnoses you with urinary hesitancy, be sure to follow their treatment plan. Take medications exactly as they prescribe and schedule follow-up appointments as often as they suggest. It’s also a good idea to track your habits and symptoms in a diary.

When should I see a healthcare provider?

Visit a healthcare provider as soon as you notice that it’s harder to urinate or if your pee stream is consistently weaker than usual. Don’t ignore your symptoms or assume they’ll get better on their own. It might feel embarrassing to talk about your pee, but it’s important to have new symptoms checked out right away.

When should I go to the ER?

Go to the emergency room if you feel like you have to pee but nothing comes out, especially if you feel pain in your abdomen or genitals.

Which questions should I ask a healthcare provider?

• What do you think is the cause of my urinary hesitancy?
• Which tests do you recommend?
• Should I get additional tests?
• What treatment do you recommend?
• Will my urinary hesitancy go away?