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Female urinary tract
Female urinary tract
Male urinary tract
Male urinary tract

Urinary hesitancy
Definition:
Urinary hesitancy is defined as difficulty in starting a urinary stream.

Alternative Names:
Delayed urination; Hesitancy; Difficulty initiating urination

Considerations:
Urinary hesitancy affects people of all ages and occurs in both sexes, but it is most common in older men with enlarged prostate glands.

Urinary hesitancy often comes on gradually. It sometimes goes unnoticed until urinary retention (complete inability to urinate) produces distention and discomfort in the bladder.

Virtually all older men have some degree of difficulty in starting urination, dribbling, or decreased force of the urinary stream.
Common Causes:
Home Care:
Voiding patterns should be monitored, recorded, and reported to the doctor. Heat applied to the lower abdomen may enhance muscle relaxation and aid urination. Crede's maneuver -- massage or pressure over the bladder (lower abdomen above the groin) will sometimes stimulate the bladder to empty.

Otherwise, follow prescribed therapy for treating the underlying cause. Infections may be treated with antibiotics. For bladder infections, drink lots of fluids (particularly fruit juices).
Call your health care provider if:
  • There are symptoms of fever, vomiting, back pain or shaking chills.
  • There is a problem associated with hesitancy, dribbling, or weak urine stream.
  • There is blood in the urine.
  • The symptoms persist for 24 hours or continue to recur.
  • There is any discharge from the urethra.
What to expect at your health care provider's office:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting the urinary hesitancy in detail may include:
  • Time pattern
    • How long has difficulty starting urine flow been noticed?
    • Did it come on gradually?
    • Is it worse in the morning?
    • Is it worse at night?
  • Quality
    • Is starting the urine flow difficult?
    • Is there decreased force of urine flow?
    • Is dribbling a problem?
    • Is controlling urine a problem?
  • Aggravating factors
    • What makes it worse?
  • Relieving factors
    • What helps?
    • Is it helped by applying heat to the lower abdomen?
    • Is it helped by massage or pressure over the bladder?
  • Other
    • What other symptoms are also present?
      • Is there fever?
      • Is there pain or burning when starting flow of urine?
      • Is there pain or discomfort in the bladder?
      • Is there pain or discomfort in the abdomen?
      • Is there pain or discomfort in the back?
      • What color is the urine?
      • Is any blood noticed?
  • Medical history
    • Is there any history of:
    • Have there been any recent injuries, surgeries, or diagnostic procedures on the pelvis or bladder?
    • Are there problems with constipation?
    • What medications are being taken?
A physical examination will be performed with special attention to the pelvic, rectal, abdominal, and lower back regions. The bladder should be palpated to determine the degree of distention. The voiding pattern may be monitored, and the bladder palpated frequently to determine distention. Crede's maneuver may be used to start the flow of urine.

Diagnostic tests that may be performed include:

Intervention:
Treatment of urinary hesitancy varies with the underlying problem. If a bacterial infection is present, antibiotics may be prescribed. A surgical procedure may be required to relieve prostate obstruction (see TURP).

After seeing your health care provider:
You may want to add a diagnosis related to urinary hesitancy to your personal medical record.

Review Date: 11/5/2001
Reviewed By: David R. Knowles M.D., Department of Urology, New York-Presbyterian Hospital Columbia Campus, New York, NY. Review provided by VeriMed Healthcare Network.
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