Why do some people have trouble starting or maintaining urine flow. What are the common causes of urinary hesitancy in men and women. How can urinary hesitancy be treated effectively. What are the potential complications of untreated urinary hesitancy. When should you see a doctor about difficulty urinating.

Understanding Urinary Hesitancy: A Common Yet Often Overlooked Problem

Urinary hesitancy, the difficulty in starting or maintaining urine flow, is a condition that affects many individuals, particularly men. This issue can manifest as trouble initiating urination, a weak urine stream, or the inability to completely empty the bladder. While it may seem like a minor inconvenience, urinary hesitancy can lead to more serious complications if left untreated.

Dr. Karyn S. Eilber, a renowned urologist, explains, “In men, the most common cause is benign prostatic hyperplasia, which is an enlarged prostate.” For women, the issue often stems from a different source. “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,” Dr. Eilber adds.

Common Causes of Urinary Hesitancy in Men and Women

Several factors can contribute to urinary hesitancy:

• Scar tissue within the urethra
• Certain medications, including some antidepressants and decongestants
• Neurological disorders like multiple sclerosis or diabetic neuropathy
• Pelvic organ prolapse in women
• Pelvic floor dysfunction

Dr. Michael Ahdoot, another expert in urology, notes, “Some of the psych meds will actually decrease the nervous outflow to the bladder. Sometimes, people can have difficulty releasing their bladder when they’re on some of those medications.”

Recognizing the Signs: When to Seek Medical Attention

Urinary hesitancy often develops gradually, making it easy to overlook. However, recognizing the signs is crucial for timely intervention. Dr. Eilber emphasizes, “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.”

Are there any red flags that indicate immediate medical attention is necessary? A complete inability to urinate, severe abdominal pain, or fever accompanying urinary symptoms should prompt an immediate visit to a healthcare provider.

The Hidden Dangers of Untreated Urinary Hesitancy

While urinary hesitancy may seem like a mere inconvenience, it can lead to serious complications if left untreated. Dr. Ahdoot warns, “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.”

What other risks are associated with untreated urinary hesitancy? Chronic urinary retention can lead to:

• Recurrent urinary tract infections
• Bladder stones
• Kidney damage
• Decreased quality of life

Diagnostic Approaches for Urinary Hesitancy

Diagnosing urinary hesitancy typically involves a combination of medical history, physical examination, and specialized tests. These may include:

1. Urinalysis to check for infections or other abnormalities
2. Uroflowmetry to measure urine flow rate
3. Post-void residual volume test to check for retained urine
4. Cystoscopy to visualize the inside of the bladder and urethra
5. Urodynamic studies to assess bladder function

How do these diagnostic tools help in determining the underlying cause of urinary hesitancy? Each test provides specific information about the urinary system’s function, helping doctors pinpoint the exact cause and develop an appropriate treatment plan.

Effective Treatment Strategies for Urinary Hesitancy

Treatment for urinary hesitancy varies depending on the underlying cause. Here are some common approaches:

• Timed voiding: For mild cases, urinating every three hours can prevent the bladder from getting too full.
• Hot baths: This may help relieve pelvic floor dysfunction by relaxing the muscles.
• Physical therapy: Exercises focused on relaxing the pelvic floor can make urination easier.
• Sacral nerve stimulation: Dr. Eilber describes this as “like a bladder pacemaker that can be very successful in helping the bladder empty better.”
• Medication: Various drugs can help shrink the prostate, relax urethral muscles, or address pelvic floor dysfunction.
• Surgery: In some cases, surgical intervention may be necessary to remove scar tissue, correct prostate issues, or address pelvic organ prolapse.

Which treatment option is most effective for each underlying cause? The effectiveness of treatment largely depends on the specific cause of urinary hesitancy. For instance, medication may be highly effective for prostate enlargement, while physical therapy might be the best approach for pelvic floor dysfunction.

Lifestyle Modifications to Improve Urinary Function

In addition to medical treatments, certain lifestyle changes can significantly improve urinary function:

1. Maintaining a healthy weight
2. Staying hydrated
3. Limiting caffeine and alcohol intake
4. Practicing pelvic floor exercises
5. Managing stress through relaxation techniques

How do these lifestyle modifications contribute to better urinary health? These changes can help reduce pressure on the bladder, improve muscle tone, and decrease irritation to the urinary system, all of which can alleviate symptoms of urinary hesitancy.

The Role of Diet in Urinary Health

Diet plays a crucial role in maintaining urinary health. Certain foods and beverages can irritate the bladder and exacerbate urinary hesitancy symptoms. These include:

• Acidic foods like citrus fruits and tomatoes
• Spicy foods
• Artificial sweeteners
• Carbonated beverages
• Caffeine and alcohol

What dietary changes can help improve urinary function? Incorporating more water-rich fruits and vegetables, whole grains, and lean proteins can support overall urinary health. Additionally, reducing intake of bladder irritants and maintaining proper hydration can significantly improve symptoms.

Preventive Measures: Maintaining Long-term Urinary Health

While some causes of urinary hesitancy are not preventable, there are steps you can take to maintain good urinary health:

1. Regular check-ups with a urologist, especially for men over 50
2. Practicing good hygiene to prevent urinary tract infections
3. Avoiding holding urine for long periods
4. Maintaining a healthy lifestyle with regular exercise
5. Managing chronic conditions like diabetes that can affect urinary function

How often should one undergo urological check-ups? For men over 50, annual prostate exams are recommended. Women should discuss urinary health with their gynecologist during regular check-ups. Anyone experiencing persistent urinary symptoms should seek medical attention promptly.

The Importance of Early Intervention

Early detection and treatment of urinary hesitancy can prevent complications and improve quality of life. Dr. Ahdoot emphasizes, “If someone notices progressive difficulty urinating, it’s important to be seen by a doctor before they are unable to urinate at all.”

What are the benefits of addressing urinary hesitancy early? Early intervention can:

• Prevent kidney damage
• Reduce the risk of urinary tract infections
• Improve overall quality of life
• Prevent the need for more invasive treatments later on

Emerging Treatments and Future Directions in Urinary Health

The field of urology is constantly evolving, with new treatments and technologies emerging to address urinary hesitancy and other urological issues. Some promising areas of research include:

• Minimally invasive surgical techniques
• Advanced drug delivery systems
• Stem cell therapies for tissue regeneration
• Artificial intelligence in diagnosing and monitoring urinary conditions

How might these advancements change the landscape of urinary health care? These innovations have the potential to offer more personalized, effective, and less invasive treatments for urinary hesitancy and other urological conditions, improving outcomes and quality of life for patients.

The Role of Telemedicine in Urological Care

Telemedicine has become increasingly important in healthcare, including urology. Virtual consultations can provide:

• Easier access to specialists
• Convenient follow-up appointments
• Timely advice for managing symptoms
• Reduced healthcare costs

How effective is telemedicine in managing urinary hesitancy? While some aspects of urological care require in-person visits, telemedicine can be effective for initial consultations, medication management, and monitoring of symptoms, making care more accessible and convenient for patients.

Psychological Impact of Urinary Hesitancy

The psychological effects of urinary hesitancy are often overlooked but can significantly impact quality of life. Patients may experience:

• Anxiety about urinating in public
• Embarrassment about their condition
• Depression due to lifestyle limitations
• Reduced self-esteem
• Strain on personal relationships

How can these psychological impacts be addressed? A holistic approach to treatment that includes psychological support, such as counseling or support groups, can be beneficial. Open communication with healthcare providers about these concerns is crucial for comprehensive care.

Coping Strategies for Living with Urinary Hesitancy

While seeking medical treatment is essential, there are several coping strategies that can help manage urinary hesitancy in daily life:

1. Planning bathroom breaks in advance
2. Using relaxation techniques when attempting to urinate
3. Staying informed about one’s condition and treatment options
4. Communicating openly with partners and family members
5. Joining support groups to connect with others facing similar challenges

How can these strategies improve quality of life for those with urinary hesitancy? By reducing stress and anxiety associated with the condition, these coping mechanisms can help individuals maintain a sense of control and normalcy in their daily lives.

The Role of Caregiver Support in Managing Urinary Hesitancy

For individuals with severe urinary hesitancy, especially those with underlying neurological conditions, caregiver support can be crucial. Caregivers can assist with:

• Medication management
• Catheterization, if necessary
• Maintaining hygiene to prevent infections
• Recognizing signs of complications
• Providing emotional support

What resources are available for caregivers of individuals with urinary hesitancy? Many hospitals and urology clinics offer caregiver training programs. Additionally, support groups and online resources can provide valuable information and emotional support for caregivers.

The Importance of Open Communication with Healthcare Providers

Effective management of urinary hesitancy relies heavily on open and honest communication with healthcare providers. Patients should feel comfortable discussing:

1. All symptoms, even if they seem embarrassing
2. Concerns about treatment side effects
3. Impact on quality of life
4. Questions about new or alternative treatments
5. Any changes in symptoms or treatment effectiveness

How can patients ensure they’re getting the most out of their healthcare appointments? Keeping a symptom diary, preparing questions in advance, and bringing a trusted friend or family member to appointments can help ensure all concerns are addressed and information is accurately understood and remembered.

Navigating Insurance and Healthcare Costs for Urinary Hesitancy Treatment

Managing the costs associated with urinary hesitancy treatment can be challenging. Here are some strategies to consider:

• Understanding insurance coverage for various treatments
• Exploring generic medication options when available
• Inquiring about patient assistance programs for expensive medications or devices
• Considering participation in clinical trials for access to new treatments
• Discussing cost concerns openly with healthcare providers to explore affordable options

What resources are available to help patients manage healthcare costs? Many pharmaceutical companies offer patient assistance programs for those who qualify. Additionally, social workers or patient advocates at healthcare facilities can often provide guidance on financial assistance options.

The Role of Support Groups in Managing Urinary Hesitancy

Support groups can play a vital role in helping individuals cope with urinary hesitancy. These groups offer:

1. A platform to share experiences and coping strategies
2. Emotional support from others facing similar challenges
3. Access to up-to-date information about treatments and research
4. Opportunities to learn about local resources and specialists
5. A sense of community and reduced feelings of isolation

How can one find a suitable support group for urinary hesitancy? Many hospitals and urology clinics offer support groups. Additionally, online forums and national organizations focused on urological health often provide virtual support group options, making it easier for individuals to connect regardless of their location.

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.