What to Know About Urinary Hesitancy

Medically Reviewed by Nazia Q Bandukwala, DO on February 18, 2024
4 min read

If you are having trouble starting to urinate or maintaining a flow, you could have urinary hesitancy. The condition occurs in both men and women. But it's more common in older men. 

Urinary hesitancy could be a result of a medical condition. If it’s not frequent, it’s probably not a problem. But if you start noticing any symptoms repeatedly, talk to your doctor. 

Urinary hesitancy is a condition in which you have difficulty urinating. You may find it challenging to start a stream or keep it flowing. Your flow may stop before your bladder is empty. 

Although urinary hesitancy affects both sexes, it's more common in men. 

People sometimes don't want to discuss urinary hesitancy with their doctors. Without proper attention, the problem may gradually progress, causing other issues like discomfort and a burning sensation during peeing.

Urinary hesitancy is often a result of other medical conditions, including:

  • Scar tissue in the urethra. The urethra is the thin tube that allows the passage of urine from the bladder. If there is scarring in the urethra, it may be hard to urinate. Scarring can result from surgery or an injury to the region. 
  • Medications. Some medications, including antidepressants, may cause urinary hesitancy. These medicines can make it difficult to relieve your bladder.  Alpha-blocker therapy (tamsulosin, etc) may be used to relax the bladder neck.
  • Pelvic organ prolapse. In this condition, the vagina or the uterus drops internally. The urethra becomes compressed, causing urinary hesitancy. 
  • Neurological disorders. Some neurological disorders, such as diabetic neuropathy, stroke, and multiple sclerosis, can cause nerve damage. In this case, the signals to empty the bladder fail to reach the brain. 
  • Pelvic floor dysfunctionWhen people are under chronic stress, they clench the muscles of their pelvic floor. This can make it difficult for them to relax these muscles when they are peeing. 
  • Female void dysfunction. In women, urinary hesitancy may be due to female void dysfunction. The term covers all conditions that cause poor coordination between the urethra and the bladder muscles. As a result, the muscles of the pelvic floor relax incompletely during urination. Besides urinary hesitancy, other symptoms of female voiding dysfunction include urinary urgency, dribbling of urine, and slow urine stream. 

The most prominent symptom of urinary hesitancy is difficulty starting a urine stream or maintaining it. Other symptoms are:

  • Lower back pain 
  • Vomiting 
  • Chills and shaking 
  • Fever 
  • Dribbling of the urine 
  • Inability to urinate 

Sometimes, urinary hesitancy can lead to urinary retention, which is a serious condition. The primary urinary retention symptoms are inability to urinate and severe abdominal pain. Other symptoms of urinary retention include: 

  • Swelling of the lower abdomen 
  • Slow urine stream
  • Feeling an urgent urge to urinate but having no success 
  • Feeling the urge to urinate again after you've just gone
  • Leaking urine without an urge or warning
  • Urinary hesitancy

Urinary retention requires immediate medical attention, so seek help right away if you have these symptoms.

The treatment for urinary hesitancy will depend on your specific condition and whether you have any other diseases. Some treatment options include:

  • Timed voiding. If you have mild urinary hesitancy, your doctor may tell you to urinate every 3 hours so that your bladder does not overfill. 
  • Physical therapy. Some exercises can help relax the pelvic floor. These exercises can help make it easier to pee. 
  • Hot baths. Sitting in a hot bath can also help relax the muscles of your pelvic floor and make it easier to urinate. 
  • Medication. Your doctor may also prescribe medicines to relax the urethral muscles. Women who have pelvic floor dysfunction are prescribed benzodiazepines that help relax the muscles of the pelvic floor. These medications have a sedative effect when taken orally. But women with urinary hesitancy use them vaginally, so they don't experience the medicine's addictive or sedative effects. 
  • Surgery. The scarring in the urethra can be removed with surgery in men and women. Men may also undergo prostate surgery. In this surgery, the surgeon removes a part of the prostate. This process makes urinating easier for men who have enlarged prostates. Surgery may also help women who have pelvic organ prolapse. The surgery adjusts their organs back in their original place, correcting the problem in the urethra. 
  • Sacral nerve stimulation. In this procedure, a device is implanted in the body. It stimulates the nerve controlling the bladder function. It can help people with pelvic floor dysfunction. 

Urinary hesitancy can be uncomfortable and may lead to other problems. If you experience any symptoms of urinary hesitancy, talk with your doctor to decide the next steps.