BPH

Urinary Hesitancy: Causes, Symptoms, Treatment

The urinary tract is an essential part of the body, carrying urine from the bladder through the urethra.

Toxins and other compounds are filtered out by the kidneys and then transported to the bladder. Thus, the urinary tract plays a vital role in eliminating toxic materials from the body.

Urinary hesitancy is a condition that can lead to complications if not treated in a timely manner.

In this post, we consider what urinary hesitancy is, why it happens, and what symptoms you need to look out for.

We also provide details on how the condition is diagnosed and what you should expect when treated for urinary hesitancy.

What Is Urinary Hesitancy?

Urinary hesitancy is a condition that refers to the difficulty that develops with a person’s ability to urinate.

In some people, starting to urinate becomes more difficult than before. In others, initiating a urine stream may not be as difficult, but maintaining the stream can become a burden.

This condition can occur in any person, regardless of their age. It is important also to note that, while urinary hesitancy is more common in older people, many young adults also experience symptoms. Both men and women can experience this condition.

Various underlying factors have been associated with urinary hesitancy.

Patients are advised to seek a physical examination from their doctor if they experience symptoms related to the condition. Failure to treat the condition can lead to a complication known as urinary retention.

The occurrence of urinary hesitancy and retention has no specific prevalence, but one study found that among 257 patients who were admitted to a post-anesthetic care unit, 7.39% had experienced urinary retention.

Causes Of Urinary Hesitancy

Several potential causes have been linked to the development of urinary hesitancy. While some of the causes known to contribute to this condition are gender-specific, others are general. Let’s consider some of the most common reasons why a person may experience symptoms linked to urinary hesitancy.

Benign Prostatic Hyperplasia

Among men, the most common reason why urinary hesitancy develops tends to be benign prostatic hyperplasia (BPH).

The risk of benign prostatic hyperplasia increases with age, which correlates with the fact that the occurrence of urinary hesitancy also tends to be more common among older individuals.

One study estimates that about 8% of men experience symptoms of benign prostatic hyperplasia at the age of 40. At the age of 60, half of the men will experience these symptoms.

Benign prostatic hyperplasia is a condition where the prostate gland, which is situated around the urethra, just below the bladder in the male body, becomes enlarged.

Prostate enlargement adds pressure to the urethra, which can cause symptoms generally associated with urinary hesitancy. This is because urine flows from the bladder through the urethra before being expelled from the body.

Prostatitis

Another condition that can cause signs of urinary hesitancy and even urinary retention in men is prostatitis.

This condition is usually caused by the presence of an infection in the prostate gland. When this particular gland is infected with bacteria, inflammation develops.

In turn, the pressure is placed on the urethra, similar to the case of benign prostatic hyperplasia. Urinary hesitancy then develops due to the pressure.

Urinary Tract Infections

Urinary tract infections can also lead to urinary hesitancy. This condition occurs when bacteria make its way into the urinary tract and causes infection in the area.

Urinary tract infections are far more common in women, but they can develop in men as well.

Studies have found that up to 40% of women experience this type of infection at least once before they turn 40. Each year, more than six million patients see a physician to be treated for a urinary tract infection.

Medication

Many people do not realize it, but certain types of pharmaceutical medications have also been shown to have an impact on urinary function.

Various drugs can affect how much a person urinates or even cause the development of urinary hesitancy. Some common drugs that have been linked to such potential side-effects include:

● Anti-allergy medication.

● Nasal decongestants.

● Some cold medicines.

● Anticholinergics.

● Antidepressants.

Disorders That Affect The Nervous System

Certain disorders affect the nervous system and can cause several problems with the body – including affect urine flow.

In addition to considering the presence of a nervous system disorder, patients should also be wary that nerve damage could also lead to similar problems.

Accidents might cause nerve damage. People who have experienced a stroke in the past may also have suffered nerve-related injury.

Diabetes mellitus is known for damaging nerves in the body. Additionally, patients with an infection in the spinal cord or brain are at a higher risk of experiencing urinary hesitancy or related problems with their ability to urinate normally.

Surgical Procedures

In some cases, undergoing a surgical procedure may also lead to urinary hesitancy. This is often an acute case of the condition and caused by the anesthesia drugs that are used on the patient.

The drug causes impairment with certain nerves in the body, which can lead to difficulty controlling the nerves that are used for starting and maintaining a urine stream.

Additionally, patients who undergo surgery on the kidneys, urethra, or the bladder, may develop urinary hesitancy when scar tissue leads to a construction of the urethra.

Other Causes And Risk Factors Of Urinary Hesitancy

Additional risk factors that can contribute to urinary hesitancy. Patients should also be wary of the following:

● Kidney stones.

● Bladder stones.

● Brain damage.

● The cancerous tumor in the urinary tract.

● Certain psychological conditions.

● Disorders that affect the bladder muscle.

● Some sexually transmitted infections can also cause these symptoms.

● Childbirth may also be a contributing factor, especially when the second stage of labor is prolonged, or when the woman suffers perineal tearing during the birth of her baby.

Symptoms Of Urinary Hesitancy

Urinary hesitancy is linked to urinary problems with a person’s urine stream.

There may be difficulty passing urine, weak urinary stream, but some people may rather find it hard to maintain their urine stream once it has started. Both symptoms may develop in a single patient as well.

In many cases, a patient may develop these symptoms over an extended period of time, which do make it challenging to identify at an early stage for a large number of individual.

This is why it is always important to take note of changing in urine flow and overall urinary control and to seek advice from a doctor if such symptoms occur.

It is also important for a patient to understand the fact that this condition can turn into urinary retention. This means the bladder cannot empty completely during urination or may even lead to complete retention of urination.

Urinary retention is considered a medical emergency. Symptoms that may indicate the presence of this particular complication include:

● The patient may not be able to start urinating at all.

● There may be a fever.

● Lower back pain is also a common symptom.

● Chills and shaking may be experienced.

● Some patients tend to start vomiting when they experience urinary retention.

If pain and fever accompany the symptoms that we mentioned above, then it may indicate the presence of an infection in the patient’s urinary tract.

Diagnosing Urinary Hesitancy

Due to the potential complications that may develop when a patient has urinary hesitancy, diagnosis is critical.

It is important to note that urinary hesitancy is generally considered a symptom of an underlying medical problem. The goal of an appointment with a doctor will be to identify what is causing the urinary hesitancy in the patient.

The doctor will start the examination by first asking the patient a range of questions regarding their symptoms.

The patient should be able to provide the doctor with the following information to ensure the physician can get a clearer view of what is going on:

● Whether the symptoms had developed suddenly or rather gradually over a period of time

● How long the patient has been experiencing the symptoms

● Whether the patient is currently experiencing a weak urine flow when they are able to urinate

● Whether the patient is able to urinate at all (this can help the physician determine if the condition has developed into urinary retention)

● The physician will also want to know if any specific elements change the severity of the patient’s symptoms

A physical examination may be taken, and the doctor will likely ask about the patient’s medical history. The patient should tell the doctor if they are taking any medication at the moment.

Supplements should also be mentioned, as these may also have interference with certain functions of the body, especially when taken together with some pharmaceutical drugs. The doctor will also want to know about any existing conditions that the patient has been diagnosed with previously.

If the patient is a male, then the doctor might want to conduct a digital rectal examination. This examination involves the doctor inserting one finger, covered in a glove and lubricated, into the man’s rectum.

The doctor will feel if there are any swelling in the area where the patient’s prostate is located, as this may signal the presence of an enlarged prostate.

The patient may also be asked to provide the doctor with a urine sample. The sample will then be tested for the presence of bacteria or other microorganisms.

This can help the physician determine if an infection might cause urinary hesitancy symptoms. There are cases where the doctor may prefer to swab the urethra’s inside – the swab will then be sent to a laboratory. This can also help to determine if an infection is present.

Other tests that might also be conducted to determine possible underlying causes of urinary hesitancy include:

● Pressure flow testing, where a catheter is used to determine the pressure on the inside of the patient’s bladder.

Uroflowmetry, which is a test that provides a reading on the flow rate when the patient urinates, as well as data on the volume of urine that is expelled when the patient’s bladder is emptied.

● Video urodynamic testing, where a special type of fluid is transferred to the bladder through a catheter. The fluid will assist in creating contract imaging while the bladder is filled and emptied.

Treatment For Urinary Hesitancy

A diagnosis of the underlying condition is required before any type of treatment protocols can be provided. The findings of the diagnosis will play a critical role in helping them determine the most appropriate way of treatment.

The following treatments may be advised for the patient:

● If the patient’s urethra swab or urine sample showed the presence of bacteria, then antibiotics might be used to fight the infection.

● If the patient has signs of an enlarged prostate, the doctor may prescribe medication that may help to reduce the inflammation that affects the prostate gland. Natural treatments, such as saw palmetto and beta-sitosterol have also been shown to improve urinary symptoms associated with BPH.

● If there is a blockage in the prostate, a surgical procedure may be advised to remove the blockage and restore normal functioning of the urinary tract.

● In cases where scar tissue had developed due to previous surgery, another surgical procedure could be advised in order to remove the scar tissue that formed in the area close to the urethra.

● There are also surgical procedures that can sometimes be used to assist in dilating the urethra, which could also reduce symptoms of urinary hesitancy.

The patient may also be advised to try certain home remedies in order to provide relief of the symptoms they are experiencing. This may include placing a heating pad or hot water bottle on the abdominal region. Pelvic floor exercises, also known as kegel exercises, can strengthen the pelvic muscles. A warm bath may also be useful in reducing the symptoms.

Conclusion

Urinary hesitancy occurs when there is difficulty in either initiating a urine stream or maintaining urination.

While the condition may seem harmless at first, failure to identify underlying diseases can lead to more serious complications. Patients should become educated about the symptoms that signal urinary hesitancy and understand when they need to take action to avoid such complications.

Sources

  1. Dal Mago AJ1, Helayel PE, Bianchini E, Kozuki H, de Oliveira Filho GR.. (2010). Prevalence and predictive factors of urinary retention assessed by ultrasound in the immediate post-anesthetic period.. Brazilian Journal of Anesthesiology. 60 (4), p:383-390.
  2. https://emedicine.medscape.com/article/233101-overview#a1
  3. Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol. 2017;4(3):148–151. doi:10.1016/j.ajur.2017.06.004
  4. Tan CW, Chlebicki MP. Urinary tract infections in adults. Singapore Med J. 2016;57(9):485–490. doi:10.11622/smedj.2016153
  5. Teo JS, Lee YM, Ho HSS. An update on transurethral surgery for benign prostatic obstruction. Asian J Urol. 2017;4(3):195–198. doi:10.1016/j.ajur.2017.06.006

About Our Author Dr. Ahmed Zayed

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Dr. Ahmed Zayed holds a baccalaureate of Medicine and Surgery. He has completed his degree at the University of Alexandria, Egypt. Founder of ZayedMD, Dr. Ahmed believes in making the knowledge as accessible as possible to patients. He had his work featured in reputable publications such as The Huffington Post. Other than his passion for writing, Dr. Ahmed spends​ his time outside the hospital at the gym or with a good book.

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