Urinary Hesitating, Straining, and Dribbling – Kidney and Urinary Tract Disorders

By

Geetha Maddukuri

, MD, Saint Louis University

Reviewed/Revised Dec 2022

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A hesitating start when urinating, a need to strain, a weak and trickling stream of urine, and dribbling at the end of urination are common symptoms of a partially obstructed urethra. In men, these symptoms are caused most commonly by an enlarged prostate Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is a noncancerous (benign) enlargement of the prostate gland that can make urination difficult. The prostate gland enlarges as men age. Men may have difficulty… read more that compresses the urethra and less often by a narrowing (stricture) of the urethra Urethral Stricture A urethral stricture is scarring that narrows the urethra. A urethral stricture may be Present from birth Develop after an infection or injury A urethral stricture most commonly results from… read more . Similar symptoms in a boy may mean that he was born with an abnormally narrow urethra or has a urethra with an abnormally narrow external opening. These symptoms are less common in women but the opening of the urethra may also be abnormally narrow in women.

A doctor examines the prostate by inserting a gloved, lubricated finger into the man’s rectum (digital rectal examination). If the prostate is enlarged, a blood test to measure the level of prostate-specific antigen (PSA) may be done. Sometimes ultrasonography of the prostate is also done. If a urethral stricture is suspected, the doctor may insert a flexible viewing tube into the bladder (cystoscopy Cystoscopy A doctor can diagnose some disorders of the bladder and urethra (for example, bladder tumors, stones in the bladder, benign prostatic enlargement) by looking through a flexible viewing tube. .. read more ).

To treat an enlarged prostate, doctors can use drugs or surgery. To treat a urethral stricture in a man, doctors may insert a catheter into the bladder through the penis and dilate (stretch) the urethra. It may be necessary to insert a hollow tube to hold the urethra open (a stent). Surgeons may rebuild the urethra or use other surgical treatments.

(See Overview of Urinary Tract Symptoms Overview of Urinary Tract Symptoms Kidney and urinary tract disorders can involve one or both kidneys, one or both ureters, the bladder, or the urethra, and in men, the prostate, one or both testes, or the epididymis. Problems… read more .)

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Straining to Urinate? – Healthy Living Center

The need to strain or push in order to urinate can be due to problems with the contractile force of the bladder or problems with obstruction of the bladder outlet and urethra. Failure to empty due to problems with the contractile force of the bladder may be due to nerve-related disorders such as spinal-cord injury, multiple sclerosis, diabetes, and the like. Failure to empty the bladder due to urethral problems is unusual in women. Some causes of obstruction of the bladder outlet in women include prior vaginal or urethral surgeries, rare strictures of the urethra, and, in rare instances, polyps or cancerous lesions.

Urinary symptoms should always be investigated to rule out some of these unusual but serious conditions. In the urologist’s office, an evaluation for these symptoms would typically include a detailed history, physical examination including a vaginal speculum examination, urinalysis, and an ultrasound measurement of bladder volume after voiding. The most important thing that this latter test would show is whether or not the bladder is completely empty. If the bladder empties completely it makes neurological problems unlikely. If the bladder retains a lot of urine, further studies with urodynamics, a bladder-pressure study that assesses the contractility of the bladder muscle, would be appropriate.

Q2. My husband has been taking oxycodone for pain management for eight weeks now. He is currently having trouble urinating. I understand this is from the medication, but what can he do to overcome the problem? Would drinking more liquid help?

— Irene, North Carolina

Oxycodone, as well as other narcotic pain medications, can lead to bladder problems. Your husband’s difficulty urinating may have resulted because the medication interacts with and blocks some of the nerve signals that cause the bladder to contract. If he cannot be switched to a nonnarcotic pain medicine, then additional evaluation is indicated to assess the severity of his urinary problems. Narcotic pain medicines can also lead to constipation, which, if severe, can prevent normal evacuation of the bladder.

It is important to know whether your husband has an underlying predisposition to bladder difficulties. If he has an enlarged prostate, for example, lower urinary tract symptoms that are caused by prostatic enlargement may be exacerbated by a narcotic pain medication. In such cases, additional medication to treat the underlying lower urinary tract symptoms related to prostatic enlargement might improve his situation. It is unlikely that increasing his fluid intake will resolve bladder-emptying problems — this could actually exacerbate them. Any evaluation of a man who has difficulty urinating would also seek other, less common problems, such as chronic prostatic infection, prostate cancer, bladder stones, and the like.

Learn more in the Everyday Health Pain Management Center.

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Difficulty urinating in women (weak stream): difficulties in older women, after sex

Difficulty urinating in women is a symptom that signals pathological changes in the body. Sometimes it manifests itself as follows:

• weak jet. When going to the toilet, you have to make an effort;

• splashing urine. The jet is sprayed;

• urine leakage. Isolation may occur in small portions or drops;

• uncontrollable and frequent urge to urinate.

If you experience any of these symptoms, contact the Promedica Medical Center in Belgorod. We are attentive to even the most delicate problems of our patients. In our clinic, you will be able to determine the exact cause of the discomfort and develop a treatment plan. With our help, you can improve your well-being and improve the quality of your own life.

Causes of difficulty urinating in women

Urination disorders are often caused by inflammatory diseases of the genitourinary system. They can also appear in the background:

• pregnancies. During the period of expectation of a child, a woman may experience difficulty urinating. The enlarged uterus presses on the bladder. Because of this, an increase in the number of urges may occur;

• hormonal changes. Problems can arise during menopause. Difficulty urinating in older women is not uncommon;

• neurogenic bladder. Another cause of difficulty in urination. A certain part of the brain is responsible for the process of urination. And when this connection is lost due to trauma and other causes, problems with urination can occur.

Diseases in which there is difficulty urinating in women

This symptom indicates a violation of the outflow of urine through the urethra. Often this is due to its compression or blockage of the lumen, which occurs due to the following pathologies:

• urethritis, pyelonephritis, cystitis. These pathologies provoke an inflammatory process in the urethra, kidneys and bladder. Because of them, swelling occurs, which can narrow the urethra or completely block it. In addition to a difficult urethra, you may notice fever, general weakness, pain in the lumbar region. Difficulty urinating in women after sex can occur against the background of postcoital cystitis;

• urolithiasis. With this pathology, solid formations occur in the bladder, kidneys and ureters. When moving, there is acute pain and trauma to the organs along which the stones move. Difficulty urinating in women occurs when the mouth of the neck is blocked;

• oncology of the urinary system. The disease also occurs in men. With the growth of tumors, irritation of the walls of the bladder occurs. You may experience problems with urination, as well as cramping, pain in the lower abdomen. Urine can be allocated in portions, the number of urges to urinate may become more frequent, some of them may be false;

• Urethral stricture. With a pathological narrowing of the urethra, there is difficulty urinating in women.

An alarming symptom also develops in some other pathologies:

• diabetes mellitus. Diabetic nephropathy provokes a violation of the emptying of the bladder;

• gout. With pathology, the accumulation of uric acid salts occurs. With the defeat of the renal apparatus, there is difficulty urinating in women;

• secondary inflammation of the genitourinary system. They arise against the background of complications.

Features of difficulty urinating in women

In order to fix the problem, it is important to determine the cause. For you to be extremely frank with your doctor. To accurately establish the clinical picture, you may need to consult related specialists. In the medical center “Promedica” you can make an appointment:

Diagnosis of diseases occurring with difficulty urinating in women

The sign itself is not a pathology. It signals other violations. When contacting a urologist, you will need to undergo a comprehensive examination:

• general and bacterial culture of urine;

• blood test;

• ultrasound examination of the prostate, bladder, kidneys;

• cystoscopy. It allows you to assess the condition of the bladder.

Treatment

Therapy depends on the cause. And when the connection between difficult urination in women and the pathology that provokes it is precisely established, treatment is prescribed. It can be carried out with the help of a course of antibiotics, anti-inflammatory, hormonal and other drugs. You can also undergo surgery or prescribe a course of physiotherapy.

Where to go if you have difficulty urinating in women?

If you have a problem, don’t put off seeing your doctor. The qualified urologists of our center will find the root cause of the symptom with the help of diagnostic procedures. They have modern equipment and laboratory methods at their disposal. After clarifying the clinical picture, you will be prescribed treatment. Accurate adherence to the recommendations of qualified specialists is a good help in recovery.

According to the patients of the clinic “Promedica”, we managed to create a comfortable and trusting environment in the center. Convince yourself of this too! To clarify the price of admission and sign up, contact us in a convenient way.

Difficulty urinating in women without pain – causes and treatment

Urination is an arbitrary process. It is controlled by the central nervous system and occurs only at the will of a person. Normally, urination occurs easily and freely, without difficulty, pain, after which the person feels the complete emptying of the bladder.

Any violation of this physiological procedure should alert: discomfort when going to the toilet may indicate serious violations of the urinary system.

The female genitourinary system differs from the male only in the structure of the urethra – the urethra, which in women is only 4 cm. This determines the gender dependence of diseases of the genitourinary system: infection of the female body through the urethra occurs much faster than the male. Therefore, it is important to pay attention to alarming symptoms as early as possible and start treatment on time. This will help prevent serious and even dangerous complications.

How to identify signs of difficulty urinating?

Difficulty urinating is one of the common signs of pathologies of the urinary system. Although this symptom is more common in men, women should also be alert for signs of urinary obstruction.

From a medical point of view, this disorder is included in the concept of “dysuria”. Dysuric syndrome combines any urination disorders. As a rule, such a clinical picture indicates diseases of the lower urinary system, however, the infection in women spreads at such a speed that a few days can become decisive, and a simple inflammation can develop into a serious infectious disease.

If there is a suspicion of problems with urine output, you can compare your situation with normal indicators of the functioning of the urinary organs.

It has been proven that a healthy body excretes about 75% of the fluid taken through the kidneys per day, that is, a person excretes about 1.5 liters of daily urine (the norm is to drink 2 liters of fluid per day).

The frequency of urination during the day for women is 4 to 9 times a day, and at night there should be no more than one trip to the toilet. If during the day the number of visits to the ladies’ room decreases sharply, there are difficulties with urination, and after this process there is a feeling of a full bladder, you need to contact a specialist to solve such problems.

It is time to see a doctor if you experience:

• weakening of the stream during urination;
• sensation of sluggishness or thinning of the jet;
• excretion of urine in drops;
• soreness during urination;
• the need for constant straining when passing urine;
• sensation of incomplete emptying of the bladder.

Causes of difficulty urinating in women

Difficulty urinating may be acute or chronic. Also, its variations differ in the mechanism of development. Therefore, it is advisable to disassemble the causes of the disease in conjunction with the options for difficult emptying of the bladder.

Ischuria

One of the most dangerous situations is the inability to empty the full bladder, which most often develops as a secondary manifestation of other pathologies. Despite the fact that ischuria can be in a chronic form, this is a rather serious condition that can turn into fatal consequences. All over the world, it is ischuria that occupies a leading position among all the reasons for providing emergency medical care.

Ischuria is accompanied by a feeling of an overfilled bladder, but the act of urination does not occur.

The most common causes of ischuria are:

• urolithiasis;
• stricture (abnormal narrowing) of the urethra;
• tumors of the genitourinary system;
• traumatic injuries of various parts of the urinary organs;
• acute inflammatory diseases;
• sclerotic processes – replacement of parts of the urinary tract with connective tissue;
• neurological disorders;
• intoxication with psychotropic substances.

To speak of chronic ischuria, the volume of residual urine must exceed 300 ml. This situation should last more than six months. In such cases, it is necessary to look for the cause of the disease, for example, an obstruction of the urinary tract, improper functioning of the kidneys, or a violation of the nervous regulation of the urinary process.

In women without concomitant diseases, ischuria most often develops gradually. It leads to inflammation of the urinary tract.

More often than other pathologies of an inflammatory nature, women are concerned about cystitis. An easy way for the spread of infection from the external genitalia becomes a risk factor for inflammation of the bladder. This disease is not dangerous with timely access to a doctor and adherence to the principles of treatment.

Stranguria

Partial obstruction of the outflow of urine, which is characterized by frequent, but scanty and often painful urination, is called stranguria. In this case, urine comes out only after straining. It is not possible to urinate fully, even despite a strong feeling of urge. Often, straining is accompanied by painful spasms, pain can spread to the pelvic organs, lower back, and abdominal muscles. The pathological condition most often occurs if there is an obstacle to the outflow of urine – tumor pressure or local narrowing of the urethra. Also, stranguria can lead to damage to the nervous system – the nervous structures that are responsible for the normal functioning of the genitourinary tract.

The most common causes of stranguria in women are:

• cancer of the urethra;
• urolithiasis, which manifests itself in the form of stones in the urethra;
• narrowing of the internal lumen of the urinary tract by a cyst or foreign body;
• Tumors of the neck or walls of the bladder.

Patients of advanced age have another problem – the weakening of the pelvic floor muscles, due to which the prolapse of the genitals occurs. This can lead to a number of unpleasant problems, including mechanical blockage of the urinary tract.

Anuria

Difficulty urinating may be associated with disorders of the renal parts of the urinary system. If there is no urine in the bladder, then the urge does not automatically occur, and the number of trips to the restroom is drastically reduced. This condition is called anuria. It can occur as a result of:

• urolithiasis;
• chronic pyelonephritis or glomerulonephritis;
• tuberculous lesions of the kidneys;
• renal amyloidosis and other storage diseases;
• severe decompensated cardiovascular diseases.

Neurogenic dysfunction

Another group of causes of urinary dysfunction is damage to the nervous system at the level of the brain or spinal cord or peripheral nerve structures. The causes of neurogenic disorders can be various pathologies of the development of the nervous system, tumors, complications after operations or other diseases. Hyporeflex activity usually leads to difficulty urinating.

In this situation, the urge to urinate is less frequent than normal. As a result, the bladder overflows, its timely emptying does not occur: urine is excreted slowly, rarely, in the form of a thin stream or drops.

Intermittent urination

Another variant of difficult urination is its intermittency: a periodic violation of the flow of urine in the process of its excretion. This can occur when a stone or a foreign body is formed in any part of the genitourinary system, as well as with uncontrolled periodic spasm of the urethra.

Other causes of difficulty urinating in women

In addition to common diseases of the genitourinary system, there are a number of diseases that can manifest as a number of urinary problems. These include:

• gout – uric acid salts accumulate during the disease, the renal apparatus is often affected;
• complications of inflammatory processes of any localization – the spread of infection within the body can lead to secondary inflammation of the organs of the genitourinary system;
• storage diseases – metabolic disorders lead to changes in the normal functioning of the urinary apparatus;
• diabetes mellitus – diabetic nephropathy often accompanies the disease and leads to the development of a number of unpleasant symptoms, including bladder emptying disorders;
• psychosomatic manifestations – in some cases, problems of the genitourinary system are associated with strong stressful effects.

Why is difficult urination dangerous?

The initial stages of urinary dysfunction are usually not dangerous for humans: the body tries to compensate for pathological urination. However, over time, the problem progresses, the volume of residual urine is constantly growing. This causes discomfort, can lead to compensatory urinary incontinence and the development of infections. The transition of stranguria into acute urinary retention is also dangerous.

Where do I go if I have problems with urination?

There is a myth that absolutely all problems associated with urination disorders are the field of activity of urologists. In fact, often the problem is not hidden in the urinary system itself (or vice versa, it is a serious disease that is treated by doctors of several specialties).

In the event of the initial occurrence of characteristic complaints, it is necessary to contact a family doctor or general practitioner. A generalist will determine the specifics of the problem and will be able to prescribe treatment on their own or refer them to the right narrow doctor.

The causes of difficulty urinating are usually determined during an appointment with a urologist or nephrologist. Also, gynecologists and neurologists can “connect” to identify related disorders of the genitourinary system in women. If the situation becomes serious, periodic complaints of difficulty urinating turn into a situation where self-excretion of urine is impossible, you need to call an ambulance. Emergency physicians will place a urinary catheter and suggest a place for follow-up hospitalization. Only in a hospital can you reliably determine the cause of acute urinary retention and successfully eliminate it.

Diagnostic measures

In order to make a correct diagnosis, doctors need to carefully collect all complaints: determine the features of urinary dysfunction, the frequency of occurrence and severity of symptoms. Also, the specialist will find out the history of the disease. It is important for him to know when the complaints first appeared, what could cause the development of pathology, whether there is a connection between changes in the functioning of the genitourinary system and other diseases.

An objective examination in women includes an examination of the lumbar region and pelvic organs, external genital organs, including a gynecologist. During the examination, the doctor evaluates Pasternatsky’s symptom – tapping on the lower back in the projection zone of the kidneys to determine kidney diseases.

Patients must take a swab from the urethra for inflammatory diseases of the lower urinary tract. In addition, standard clinical blood and urine tests are prescribed, additional studies to assess renal function and the content of pathogenic microflora. Such analyzes include determining the amount of daily urine, samples for assessing the composition of urine, bacteriological culture with the detection of the sensitivity of pathogens to various antibiotics.

Of the instrumental diagnostic methods, an important role is played by ultrasound of the kidneys and pelvic organs, as well as a more detailed visualization of problem areas of the genitourinary system – CT and MRI.

If necessary, psychotherapeutic counseling is provided: some disorders of the genitourinary system may be the result of psychological problems.

Treatment

To normalize the function of urination, first of all it is necessary to determine why such disorders occur. In acute urinary retention, urethral catheterization is mandatory, which can be temporary or permanent.

If the disorders are caused by infectious and inflammatory processes, antibiotics and anti-inflammatory drugs are prescribed, which eliminate the cause of the disease.

If it is possible to eliminate the mechanical narrowing of the lumen of the urethra, operations or other manipulations are performed to free the paths of urine flow. Restoring the functioning of nerve structures is a complex task, the success of which depends on the type of nerve pathology.

The treatment of psychogenic conditions remains complex and ambiguous, when there are no visible disorders of organs and their functions, but signs of difficulty urinating appear.