Urinary Hesitancy - Causes, Symptoms, and Treatment

Introduction:

Urinary hesitancy is a condition in which a person experiences difficulty in managing a steady stream of urine flow even when the bladder is not empty. This condition can affect people of all age groups and genders, but it is more common in men. Few patients have urinary hesitancy that is gradual in onset and asymptomatic, causing delays in seeking treatment. If left untreated, it may cause urinary retention, resulting in urinary bladder infections and kidney damage. The article provides insights into the causes, symptoms, and management of urinary hesitancy.

What Are the Causes of Urinary Hesitancy?

Urinary hesitancy is a symptom of an underlying condition that affects the urinary system. The most common causes of urinary hesitancy include:

• Prostate Enlargement: Prostate gland is a small gland located below the bladder in men. As men age, the prostate gland can become enlarged, which can put pressure on the urethra (a hollow tube through which urine leaves the body), making it difficult to urinate.

• Medications: Some medications, such as decongestants (pseudoephedrine, to relieve blocked nose) or antidepressants (to treat depression or anxiety), can cause a reduction in nerve stimulation, making it difficult to pass urine.

• Nerve Damage: It can occur due to conditions such as multiple sclerosis (an autoimmune disorder damaging the brain and spinal cord membrane) or spinal cord injuries. The nerves that control the bladder and urethra are affected due to these health conditions. Nerves are also damaged due to accidents, stroke (interruption of blood supply to the brain), childbirth, diabetes, and brain or spinal cord infections.

• Bladder Outlet Obstruction: Bladder outlet obstruction occurs when there are physical blocks to the flow of urine out of the bladder, such as a bladder stone or a tumor.

• Neurological Disorders: Neurological disorders such as Parkinson's disease (central nervous system disorder that affects movement) or diabetic neuropathy (nerve damage due to diabetes) can affect the nerves that control the bladder and urethra.

• Anxiety and Stress: Anxiety and stress can affect the body's ability to urinate by increasing tension in the pelvic muscles and causing urinary hesitancy.

• Aging: As we age, the muscles in the bladder and urethra may weaken, which can cause urine flow difficulties.

• Scar Tissue Within the Urethra: A thin tube exiting the bladder is known as the urethra. Scar formation within the tube results in the narrowing of the urethra, making it difficult to urinate. It is caused by surgery, injury, or catheter placement.

• Pelvic Organ Prolapse: Internal drop of organs like the uterus or vagina causes compression of the urethra leading to obstruction of urine flow.

• Pelvic Floor Dysfunction: Chronic stress can make individuals clench their pelvic floor muscles. It causes difficulties in the relaxation of pelvic floor muscles.

• Surgery: Surgical procedures on the bladder, kidney, or urethra can cause scar tissue formation or nerve damage, causing urinary hesitancy.

• Infections: In patients with prostatitis (redness and swelling of the prostate gland), the prostate gland can swell and apply pressure on the urethra, causing difficulties in urination. Other infections like urinary tract infections and sexually transmitted infections can affect urine flow.

• Shy Bladder Syndrome (Paruresis): In rare instances, psychological conditions like paruresis (experiencing difficulty or inability to pee) may cause urinary hesitancy in the presence of others or in public places.

What Are the Symptoms of Urinary Hesitancy?

The main symptom of urinary hesitancy is difficulty starting or initiating urination. Other symptoms may include:

• Weak or interrupted urine stream.

• Dribbling at the end of urination.

• Straining to pass urine.

• Feeling like the bladder is not empty after urination.

• Needing to urinate frequently, especially at night.

• Pain or discomfort during urination.

• A feeling of urinary urgency, but being able to relieve urine in small amounts.

• Incomplete emptying of the bladder causes urinary retention and ultimately leads to urinary tract infections.

• In rare instances, patients may develop fever, chills, lower back pain, or vomiting. Such individuals must seek immediate treatment to prevent the worsening of their health.

How to Diagnose Urinary Hesitancy?

Medical history on the duration of the disease, onset, volume of urine, and relieving or aggravating factors can help with diagnosis. Past medical conditions and prescriptions can help with treatment planning. A sample of urine is collected for analysis.

• During bladder emptying, the volume and flow rate of expelled urine is analyzed with uroflowmetry.

• The pressure within the bladder is measured by pressure flow testing. A catheter is required for pressure assessment, and the results are compared with the flow rate during urination.

• Video urodynamic testing is a technique in which a special liquid is placed in the bladder with the help of a catheter. It helps create a contrasting image during bladder emptying and filling.

• In males, a rectal prostate exam is necessary for visualizing abnormalities in the prostate gland. Ultrasound or other imaging techniques may be helpful for evaluation.

What Are the Treatment Options for Urinary Hesitancy?

The treatment for urinary hesitancy depends on the underlying cause of the condition. Here are some treatment options that healthcare providers may recommend:

• Timed Voiding: In patients with mild symptoms of urinary hesitancy, urinating every three hours can prevent the bladder from becoming full.

• Hot Baths: Sitting in a hot bathtub can relax pelvic muscles and overcome pelvic floor dysfunction.

• Physical Therapy: Exercises that relax pelvic floor muscles can help with urination.

• Sacral Nerve Stimulation: A surgically implanted device can stimulate the nerve that controls the bladder. It can also help overcome pelvic floor dysfunction.

• Medications: If the cause of urinary hesitancy is an enlarged prostate gland, medications such as Alpha-blockers or 5-alpha reductase inhibitors may be prescribed to help relax the muscles in the prostate and improve urine flow. Women with pelvic floor dysfunction are treated with Benzodiazepines to relax pelvic muscles.

• Biofeedback: It is a technique that uses electronic devices to help create awareness about the patient’s pelvic muscles and aid them in learning how to control them better.

• Surgery: It may be recommended in severe cases. The procedure helps relieve urinary obstruction caused by an enlarged prostate or bladder outlet obstruction. Surgical removal of scar tissue may help with urination. In pelvic organ prolapse, surgery is required to secure organs in place and relieve urethral compression.

• Catheterization: In some cases, intermittent catheterization may be recommended to help empty the bladder.

• Lifestyle Changes: Making changes to lifestyle, such as diet, exercise, and managing stress, may help alleviate urinary hesitancy symptoms in some cases.

• Treat Underlying Conditions: Treating underlying conditions such as urinary tract infections, nerve damage, or neurological disorders may help improve urinary hesitancy symptoms.

Conclusion

Urinary hesitancy is a condition that can affect people of all ages and genders. The main symptom of urinary hesitancy is difficulties in a steady stream of urine flow. The underlying causes of urinary hesitancy can vary, including prostate enlargement, medication, nerve damage, or urinary tract infections. Treatment options include medication, surgery, self-care, and management of underlying conditions. It is important for patients experiencing urinary hesitancy to consult doctors to determine the underlying cause and plan treatment options.