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

Delayed urination; Hesitancy; Difficulty initiating urination

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 usually comes on slowly over time. You may not notice it until you are unable to urinate (urinary retention), and your bladder swells and becomes uncomfortable.

Almost all older men have some trouble with:

• Dribbling
• Starting urination
• Weaker urine stream

Urinary hesitancy can be caused by:

• Drugs (some cold remedies, some nasal decongestants, tricyclic antidepressants, and anticholinergic drugs used for incontinence)
• Enlarged prostate (benign prostatic hyperplasia)
• Inflammation or infection of the prostate gland (prostatitis)
• Nervous system disorders
• Recent surgery (postoperative retention)
• Scar tissue (stricture)
• Shy or bashful bladder syndrome (being unable to urinate when another person is in the room)
• Urinary tract infection

• Monitor, record, and report your urination patterns 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 stimulate emptying.
• Drink plenty of fluids.
• For infections, you will need antibiotics from your doctor. Symptoms of a possible infection include burning or pain with urination, frequent urination, cloudy urine, and a sense of urgency (strong, sudden urge to urinate).
• Pay close attention to any medicines or supplements you take.

See also:

• Enlarged prostate - after care
• Prostatitis - bacterial - self-care

Call your doctor for urinary hesitancy, dribbling, or a weak urine stream if you have not already been evaluated for these problems.

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

Your doctor will take your medical history and perform a physical examination, paying special attention to your pelvis, rectum, abdomen, and lower back.

Medical history questions may include:

• How long have you had difficulty starting your urine flow?
• Did it come on over time or suddenly?
• Is it worse in the morning or at night?
• Is the force of your urine flow decreased?
• Do you have dribbling?
• Do you ever leak urine uncontrollably?
• Does anything help? Like heat or massage to the lower abdomen?
• Does anything make the hesitancy worse?
• Do you have other symptoms like fever, pain or burning when you urinate, cloudy or bloody urine, back or side pain?
• Do you have a history of bladder or kidney infection? Prostate enlargement or infection? Nervous system disorders?
• Have you had a recent injury, surgery, or procedure on the pelvis or bladder?
• What medications do you take, including over-the-counter drugs?

Tests that may be performed include:

• Catheterization of the bladder to determine residual urine volume and to get urine for culture (a catheterized urine specimen)
• Cystometrography
• Transrectal ultrasound of the prostate (similar to a transvaginal ultrasound)
• Urethral swab for culture
• Urinalysis and culture
• Voiding cystourethrogram

Treatment for urinary hesitancy depends on the cause. Often, medications such as alpha-blockers can relieve the symptoms. If you have a bacterial infection, your health care provider may prescribe antibiotics. You may need surgery to relieve a prostate obstruction (see TURP).

Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 3.

Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116.

Zeidel ML. Obstructive uropathy. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 125.