Why You May Have Trouble Peeing, Plus Solutions to Help

CS-Blog

Cedars-Sinai Blog

Jul 15, 2021
Lisa Fields

What if you’ve gotta go, but you’re having trouble making it happen?

If you have trouble peeing—known as urinary hesitancy—you may have difficulty starting the stream of urine or keeping it flowing, or your flow may stop before your bladder is empty. Many factors may contribute to the problem.

Both men and women may experience difficulty peeing, but it’s more common among men. Women are more likely to have the opposite problem: urinary incontinence.

“In men, the most common cause is benign prostatic hyperplasia, which is an enlarged prostate,” says urologist Dr. Karyn S. Eilber. “A woman can have what’s called bladder prolapse, also known as a ‘fallen bladder.’ If the bladder shifts or falls, it can actually block the urethra, and the woman will have difficulty emptying her bladder.”

Urology

“People get used to having a weak stream, then all of sudden, they can’t pee. If someone notices progressive difficulty urinating, it’s important to be seen by a doctor before they are unable to urinate at all.”

Michael Ahdoot, MD

Other factors that may cause urinary hesitancy include:

• Scar tissue within the urethra, the thin tube that exits the bladder. Scarring may narrow the urethra, making it harder to pee. It may develop after an injury, surgery or catheter placement.
• Certain medications, including some antidepressants and the decongestant pseudoephedrine. “Some of the psych meds will actually decrease the nervous outflow to the bladder,” says urologist Dr. Michael Ahdoot. “Sometimes, people can have difficulty releasing their bladder when they’re on some of those medications.”
• Neurological disorders, including multiple sclerosis or diabetic neuropathy, which may cause nerve damage that makes it harder for the bladder to alert the brain that it needs to be emptied. 
• Pelvic organ prolapse, when the uterus or vagina drops internally, compressing the urethra.
• Pelvic floor dysfunction, when people clench their pelvic floor muscles in response to chronic stress. This makes it harder to relax the muscles during urination.

Magazine: Symptoms Men Shouldn’t Ignore

People don’t always tell their doctors about urinary hesitancy. It may develop so gradually that you may not realize anything has changed, and it doesn’t cause worrisome symptoms—such as burning or discomfort.

“People get used to having a weak stream, then all of sudden, they can’t pee,” Dr. Eilber says. “If someone notices progressive difficulty urinating, it’s important to be seen by a doctor before they are unable to urinate at all.”

Urinary hesitancy may seem like a mild annoyance, but left untreated, it may cause bladder infections or even kidney damage.

“If a lot of urine accumulates in the bladder, the pressure that develops can be transmitted to the kidneys and can, over time, damage the kidneys,” explains Dr. Ahdoot.

Read: What You Need to Know About Kidney Stones

To manage urinary hesitancy, doctors may recommend:

• Timed voiding. For mild cases, peeing every three hours prevents the bladder from getting too full. Trying to go again immediately after peeing also helps.
• Hot baths. This may relieve pelvic floor dysfunction. Sitting in a tub may relax pelvic floor muscles.
• Physical therapy. Exercises focused on relaxing the pelvic floor may make it easier to pee.
• Sacral nerve stimulation. An implanted device stimulates the nerve that controls bladder function, which may help with pelvic floor dysfunction. “It’s like a bladder pacemaker that can be very successful in helping the bladder empty better,” Dr. Eilber says.
• Medication. Men may benefit from prescription drugs that shrink the prostate or relax muscles in the urethra. Women with pelvic floor dysfunction may benefit from benzodiazepines prescribed as vaginal suppositories, which relax pelvic floor muscles. When given vaginally, they don’t have sedating or addictive side effects.
• Surgery. Men and women may have surgery to remove scar tissue from within the urethra. Men may also pee more easily after prostate surgery: Part of the prostate may be removed or vaporized, or sutures can tack it open. Women with pelvic organ prolapse may have surgery to secure their organs in place, correcting the kink in the urethra.

Read: Who Should Get a Prostate Cancer Screening and When?

Learn more about the Department of Urology at Cedars-Sinai

Why You Shouldn’t Push When You Pee

We’ve all been there, haven’t we? You hear the baby crying upstairs and so you try to rush along your bathroom visit so you can go comfort her. You’re racing to your next meeting and you only have a minute to stop for the bathroom. You’re late for a doctor’s appointment but you just need that quick bathroom visit before you leave. Sometimes peeing is a necessary evil that gets in the way of our daily lives. 

But if you’re someone who is moving so fast that you push when you pee, you could be setting yourself up for some problems down the road. 

How the bladder works when we pee.

The bladder works best by relaxing the pelvic floor and abdominal muscles when you need to pee, so that the bladder muscles naturally allow the flow of urine to occur. You should not be actively pushing the urine out by bearing down or by tensing your pelvic floor muscles.   

Potential problems when you push.

• You’ll start to create muscle confusion. Over time, if you’re constantly pushing out your pee when you should be just relaxing your muscles to allow urination to occur naturally, you’ll start to confuse your muscles. They’ll think that each time you pee, you should be activating the pelvic floor vs. relaxing it, creating more problems down the road. 
• Hypertonic Pelvic Floor issues. If you already suffer from a hypertonic pelvic floor (a pelvic floor that is too tense), pushing out your pee could aggravate the muscles even more and lead to other conditions, like pain or overactive bladder.
• You may develop a prolapse. Over time, consistent pushing when you pee (or poop) may cause your pelvic floor muscles to weaken, leading to pelvic organ prolapse, a condition where one of your pelvic organs (the bladder, uterus, or rectum) collapses into the vaginal canal.
• You could develop, or worsen, hemorrhoids. Hemorrhoids are swollen veins inside and outside the anus and rectum that can become very painful and cause bleeding. There are lots of causes for hemorrhoids, but straining while on the toilet can contribute to them.

Conditions that may be causing you to push when you pee.

If you feel like you have to push when you pee, there could be something else going on that you need to have treated.

In men, BPH, or benign prostate hyperplasia, can sometimes cause swelling to occur in the prostate, leading to a weak flow, or even trouble getting urination started at all. This may lead to men naturally trying to “push” their urine out.

Women with pelvic organ prolapse, a condition that causes one of the pelvic organs to protrude into or even through the vaginal canal may find it difficult to start urination, causing them to “push” to get it going. 

If you feel you absolutely must push when you urinate, you should see a doctor about the potential causes. 

The Correct Way To Pee

The best way to empty your bladder is to:

• Take a deep belly breath, fully relax, and be present during the process.