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

Urinary hesitancy affects people of all ages and occurs in both sexes. However, it is most common in older men with an enlarged prostate gland. Urinary hesitancy most often develops slowly over time. You may not notice it until you are unable to urinate (called urinary retention). This causes swelling and discomfort in your bladder.

Causes

The most common cause of urinary hesitancy in older men is an enlarged prostate. Almost all older men have some trouble with dribbling, weak urine stream, and starting urination. Another common cause is infection of the prostate or urinary tract.

Symptoms of a possible infection include:

  • Burning or pain with urination
  • Frequent urination
  • Cloudy urine
  • Sense of urgency (strong, sudden urge to urinate)

The problem can also be caused by:

  • Some medicines (such as remedies for colds and allergies) 
  • Antidepressants
  • Some drugs used for incontinence
  • Vitamins and supplements
  • Nervous system disorders
  • Side effects of surgery
  • Scar tissue (stricture) in the tube leading from the bladder

Home Care

Steps you can take to care for yourself include:

  • Keep track of your urination patterns and bring the report to your doctor.
  • Apply heat to your lower abdomen (below your belly button and above the pubic bone). This is where the bladder sits. The heat relaxes muscles and aids urination.
  • Massage or place light pressure over your bladder to help the bladder empty.

When to Contact a Medical Professional

Call your doctor if you notice urinary hesitancy, dribbling, or a weak urine stream.

Call your doctor right away if:

  • You have a fever, vomiting, side or back pain, shaking chills, or are passing little urine for 1 to 2 days.
  • You have blood in your urine, cloudy urine, a frequent or urgent need to urinate, or a discharge from the penis or vagina.
  • You are unable to pass urine.

What to Expect at Your Office Visit

Your doctor will take your medical history and do an exam to look at your pelvis, rectum, abdomen, and lower back.

Your doctor may ask questions such as:

  • How long have you had the problem and when did it start?
  • Is it worse in the morning or at night?
  • Is the force of your urine flow decreased? Do you have dribbling or leaking urine?
  • Does anything help or make the problem worse?
  • Do you have symptoms of an infection?
  • Have you had other medical conditions or surgeries that could affect your urine flow?
  • What medicines do you take?

Tests that may be performed include:

  • Catheterization of the bladder to determine how much urine remains in your bladder after trying to urinate and to get urine for culture (a catheterized urine specimen)
  • Cystometrography
  • Transrectal ultrasound of the prostate
  • Urethral swab for culture
  • Urinalysis and culture
  • Voiding cystourethrogram

Treatment for urinary hesitancy depends on the cause, and may include:

  • Medicines to relieve the symptoms of an enlarged prostate.
  • Antibiotics to treat any infection. Be sure to take all your medicine as directed.

Surgery to relieve a prostate blockage (TURP)

Now there is a minimally invasive procedure, UroLift.

The UroLift System: made by NeoTract Inc. of Pleasanton, Calif. is the first permanent implant to relieve low or blocked urine flow in men age 50 and older with an enlarged prostate. By pulling back prostate tissue that presses on the urethra, the system allows more natural urine flow. This procedure is compared to pulling back the curtains with a sash. The procedure can be done in the doctor’s office under a local anesthetic and will actually open up the urethra to allow the flow of urine and reduce the urinary symptoms of frequency of urination, improve the force and caliber of the urine stream, and, decrease the number of times a man needs to get up at night to empty his bladder.

Of course with any procedure there may be side effects and complications. Some patients reported pain or burning during urination, increased urgency, decreased urine flow, incomplete bladder emptying, and blood in the urine. Most of these symptoms, and side effects were temporary and resolved a few days or weeks after the UroLift was performed.

Bottom Line: Millions of American men suffer from symptoms as a result of an enlarged prostate gland. Certainly medications are a first line treatment option. However, the UroLift may be a permanent solution to this common problem and help men get a good night’s sleep!

Contact our office for more information.