What Causes Urinary Hesitancy?

Conditions list medically reviewed by George Krucik, MD, MBA

If you have trouble starting to urinate or maintaining urine flow, you may have urinary hesitancy. It can occur in men and women at any age, but it’s most common in older men. In some cases, it may lead to urinary retention. This happens when... Read More

If you have trouble starting to urinate or maintaining urine flow, you may have urinary hesitancy. It can occur in men and women at any age, but it’s most common in older men. In some cases, it may lead to urinary retention. This happens when you’re unable to urinate. It can be very serious.

Urinary hesitancy can result from a variety of medical conditions. If you experience it, make an appointment with your doctor. They can help pinpoint the cause of your condition and offer treatment options.

Causes of urinary hesitancy

There are many possible causes of urinary hesitancy. In men, the condition is usually caused by a benign enlarged prostate (benign prostatic hyperplasia). In both men and women, it may also result from:

  • bladder muscle disorders
  • nerve damage
  • surgeries
  • infections
  • psychological issues
  • certain medications
  • a cancer tumor obstructing the urethra or urinary bladder

Enlarged prostate

If you’re male, you have a prostate gland. It surrounds your urethra. Your urethra is the tube that carries urine from your bladder to the outside of your body.

Many men develop a benign enlarged prostate as they get older, according to the National Association for Continence. As it swells within the center of the prostate gland, it puts pressure on the prostatic urethra. This pressure makes it harder to start and maintain the flow of urine.

Nervous system disorders and nerve damage

Damaged or diseased nerves can also interfere with your flow of urine. Nerves can be damaged by accidents, strokes, childbirth, diabetes, or brain or spinal cord infections. Multiple sclerosis and other nervous system disorders can also lead to nerve damage.

Surgery

Anesthesia administered during surgery can impair some of your nerves. This can result in urinary difficulties afterward. Surgery on your bladder, kidneys, or urethra can also create scar tissue that constricts your urethra. This can cause urinary hesitancy.

Infection

Prostatitis is fairly common in men. It’s inflammation of the prostate gland that could be due to infection. It can cause the prostate to swell and put pressure on your urethra. This can result in urinary hesitancy.

Urinary tract infections and sexually transmitted infections can also lead to problems with urine flow in both men and women.

Shy bladder syndrome (Paruresis)

In rare cases, urinary hesitancy may be a sign of a psychological condition. If you feel uncomfortable about urinating in the presence of others, you may find it hard to urinate in certain situations. For example, you may experience urinary hesitancy when using public bathrooms.

Medications

Certain medications can also cause problems with urination. For example, certain cold treatment medications, nasal decongestants, and antiallergy medications can affect your urination. Anticholinergics, which are used to treat stomach cramps, muscle spasms, and incontinence, can also cause urinary retention and hesitancy. Antidepressants may also affect your urinary habits.

Seeking medical help for urinary hesitancy

If you’re experiencing persistent or recurring urinary hesitancy, visit your doctor. They can help determine the cause of your condition and recommend treatment to help relieve your symptoms.

In some cases, urinary hesitancy may be a sign of an emergency medical condition. You should seek immediate help if you experience difficulty urinating along with vomiting, fever, shaking, chills, or low back pain. You should also get emergency help if you can’t urinate at all. This condition is called urinary retention. It can become very serious if not treated quickly enough.

Diagnosing urinary hesitancy

To diagnose the underlying cause of urinary hesitancy or other problems with urination, your doctor will likely start by taking your medical history. For example, they’ll want to know:

  • how long you’ve been experiencing urinary hesitancy
  • if it developed gradually or suddenly
  • if your urine flow is weak
  • if anything seems to relieve or worsen your symptoms

They may also ask you about other symptoms that you’ve experienced. Be sure you mention any other medical conditions that you’ve been diagnosed with and any medications or supplements that you’re taking.

Your doctor may also order one or more tests to help determine the cause of your symptoms. For example, they may collect a sample of your urine for analysis. They may swab the inside of your urethra. In some cases, they may need to insert a small flexible tube, known as a catheter, into your urethra. This allows them to collect a sample of urine directly from your bladder.

Your doctor may also conduct one or more of the following urodynamic studies:

  • Uroflowmetry measures the volume and flow rate of urine expelled when you empty your bladder.
  • Pressure flow testing requires a catheter to measure the pressure in your bladder, which is then compared to the flow rate during urination.
  • Video urodynamic testing uses a special fluid placed via catheter into your bladder in order to create contrast imaging during filling and emptying of the bladder.

If you’re male, your doctor may conduct a rectal prostate exam. They may also create an image of your prostate using an ultrasound or other imaging technology.

Treating urinary hesitancy

Your doctor’s recommended treatment plan will depend on the underlying cause of your symptoms. Depending on your diagnosis, they may recommend medications, surgery, or other treatments.

In some cases, home remedies may help relieve your symptoms. For example, it may help to place a hot water bottle or heating pad on your lower abdomen. This can help relax your muscles and may improve your urine flow. Gently massaging the area may also help increase urine flow. It’s also important to drink plenty of fluids.

Outlook for urinary hesitancy

If you ignore problems with urine flow, your symptoms may get worse. Urination may become difficult to the point of impossible, leading to urine retention. This condition can be painful and serious.

It’s best to visit your doctor as soon as you experience problems with your flow of urine. Following their recommended treatment plan may help improve your short- and long-term outlook. Ask them for more information about your specific diagnosis, treatment options, and outlook.


10 possible conditions

This feature is for informational purposes only and should not be used to diagnose. Please consult a healthcare professional if you have health concerns.

Conditions list medically reviewed by George Krucik, MD, MBA