Health Encyclopedia

Urination - difficulty with flow

Definition

Difficulty starting or maintaining a urinary stream is called urinary hesitancy.

Alternative Names

Delayed urination; Hesitancy; Difficulty initiating urination

Considerations

This problem affects people of all ages and occurs in both sexes, but it is most common in older men with enlarged prostate glands.

Urinary hesitancy usually comes on gradually. It sometimes goes unnoticed until urinary retention (complete inability to urinate) produces distention and discomfort in the bladder.

Almost all older men have some degree of difficulty in starting urination, dribbling, or decreased force of the urinary stream.

Common Causes

Urinary hesitancy can be caused by:

Benign prostatic hyperplasia (enlarged prostate)
Urinary tract infection, especially if chronic and recurrent
Prostatitis (inflammation or infection of the prostate gland)
Drugs (some cold remedies, some nasal decongestants, tricyclic antidepressants, and anticholinergics which may be used for incontinence)
Shy or bashful bladder syndrome in younger people (unable to urinate when another person is in the room)
Neurologic disorders

Home Care

Monitor, 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 lies. The heat relaxes muscles and aids urination.
Massage or place light pressure over your bladder to stimulate emptying.
Drink plenty of fluid, especially fruit juices like cranberry.
For infections, antibiotics from your doctor will be needed. Symptoms that suggest a possible infection include burning or pain with urination, frequent urination, cloudy urine, and a sense of urgency (strong, sudden urge to urinate.)

Call your health care provider if

If you have not been evaluated for this problem previously, you should call your doctor for urinary hesitancy, dribbling, or weak urine stream.

Call your doctor right away if you have fever, vomiting, side or back pain, shaking chills, or passing little urine for 1-2 days.

Call if you have blood in your urine, cloudy urine, frequent or urgent need to urinate, or a discharge from the penis or vagina.

What to expect at your health care provider's office

Your 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 urine flow?
Did it come on gradually 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? Neurologic disorders?
Have you had a recent injury, surgery, or diagnostic procedures on the pelvis or bladder?
What medications do you take, including over the counter drugs?

Diagnostic tests that may be performed include:

Urinalysis and culture
Urethral swab for culture
Transrectal ultrasound of the prostate (similar to a transvaginal ultrasound)
Catheterization of the bladder to determine residual urine volume and to obtain urine for culture (a catheterized urine specimen)
Cystometrography
Voiding cystourethrogram

Treatment of urinary hesitancy varies depending on the underlying cause. If a bacterial infection is present, antibiotics may be prescribed. A surgical procedure may be required to relieve prostate obstruction (see TURP).

References

Bass PF. Urinary tract infections. Prim Care. 2003; 30(1): 41-61, v-vi.

Hua VN. Acute and chronic prostatitis. Med Clin North Am. 2004; 88(2): 483-494.

Review Date:7/23/2007
Reviewed By:Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care, Denville, NJ. Review provided by VeriMed Healthcare Network.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.