Why You May Have Trouble Peeing, Plus Solutions to Help

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Urinary hesitancy—the medical term for having trouble peeing—is when you need to pee but have difficulty starting the stream of urine or keeping it flowing, or when the flow of urine stops before your bladder is empty.

Both men and women may experience difficulty peeing, but it’s more common among men.

What Does It Feel Like When You Have Trouble Peeing?

When you have difficulty urinating, you might have a hard time starting the stream of urine, the stream of urine may be weak or slow when you pee, or the stream of urine may stop and start as you pee. You may feel like you have to strain or really push to urinate, or your urine stream may stop before your bladder is empty.

People get used to having a weak stream while peeing, and then all of sudden, they can’t pee. If you notice you’re having progressive difficulty urinating, it’s important you see a doctor before you’re unable to urinate at all.

Some people who have trouble peeing may produce only a little bit of urine despite feeling an urgent need to pee, which can be a sign of a severe blockage.

Common Causes of Difficulty Urinating in Men

As men get older, their risk for urinary hesitancy increases.

“In men, the most common cause of urinary hesitancy is an enlarged prostate, which is also known as benign prostatic hyperplasia, or BPH,” said Cedars-Sinai urologist Karyn Eilber, MD.

Another frequent cause of urinary hesitancy in men is scarring within the urethra, the thin tube that exits the bladder. This scarring can occur after an infection, injury, surgery or catheter placement.

Common Causes of Difficulty Urinating in Women

“A woman who has difficulty peeing may have bladder prolapse, also known as a ‘fallen bladder.’ If the bladder shifts or falls, it can actually block the urethra, and the woman will have difficulty emptying her bladder,” Eilber explained.

Women may also experience difficulty peeing due to a pelvic organ prolapse (POP), which is when a woman’s uterus or vagina drops internally. When the pelvic organs drop, they may compress the urethra and lead to urinary hesitancy.

If a woman has difficulty urinating due to POP, her urinary hesitancy will often grow worse as the day goes on and the pelvic organs “fall,” and then get better in the morning when the pelvic organs have gone back into normal position.

Pelvic floor dysfunction is another common cause of urinary hesitancy in women. When women clench their pelvic floor muscles in response to pain or stress, it can make it harder to relax the muscles during urination.

Other Possible Causes for Urinary Hesitancy

If you take certain medications, including specific antidepressants and the decongestant pseudoephedrine, it could affect how you pee.

“Some over-the-counter medications for treating a runny nose, such as phenylephrine, can make urination more difficult—especially in people with an underlying issue,” said Cedars-Sinai urologist Michael Ahdoot, MD. “In some cases, taking these medications can cause a complete blockage of urination.”

Additionally, neurological disorders such as multiple sclerosis or diabetic neuropathy may cause nerve damage that makes it harder for the bladder to alert the brain when it needs to be emptied.

Talk to Your Doctor If You Have Difficulty Urinating

People don’t always tell their doctors about urinary hesitancy. Sometimes, it develops so gradually that you may not realize anything has changed. It also typically doesn’t cause worrisome symptoms—such as burning or discomfort.

“People get used to having a weak stream while peeing, and then all of sudden, they can’t pee,” Eilber said. “If you notice you’re having progressive difficulty urinating, it’s important you see a doctor before you’re unable to urinate at all.”

Urinary hesitancy may seem like a mild annoyance, but if left untreated, it can cause bladder infections or even kidney damage.

“If a lot of urine accumulates in the bladder, the pressure that develops can be transmitted to the kidneys. If it’s not addressed, it can, over time, damage the kidneys,” explained Ahdoot.

How Do Doctors Treat Urinary Hesitancy?

If you have difficulty urinating, your doctor will do a thorough medical examination and may refer you to a urologist—a doctor who specializes in diagnosing and treating conditions of the urinary tract, which includes the bladder, kidneys and urethra.

After determining what is making it hard for you to pee, the doctor will recommend a treatment plan that addresses the underlying cause. Your treatment may include any of the following.

Behavioral Strategies

Timed voiding—or peeing at specific times throughout the day—is a behavioral strategy for treating mild urinary hesitancy. Peeing every three hours prevents the bladder from getting too full.

Trying to go again immediately after peeing may also help with urinary hesitancy.

Pelvic Floor Therapy

Physical therapy exercises focused on relaxing the pelvic floor muscles may make it easier to pee.

For patients who have difficulty urinating due to pelvic floor dysfunction, sitting in a tub full of warm water may relax their pelvic floor muscles and help them pee.

Medications

Men who have difficulty peeing may benefit from prescription drugs that shrink the prostate or relax muscles in the urethra.

Women with pelvic floor dysfunction who have trouble urinating may benefit from benzodiazepines prescribed as vaginal suppositories. When given vaginally, benzodiazepines help relax pelvic floor muscles without sedating or addictive side effects.

Nerve Stimulation

Doctors can implant a device to stimulate the sacral nerve, which controls bladder function.

“It’s like a bladder pacemaker, and it can be very successful in helping the bladder empty better,” Eilber said.

Surgery

Men and women may have surgery to remove scar tissue from within the urethra, if present.

Men with BPH may also pee more easily after prostate surgery, which involves removing or vaporizing part of the prostate or using sutures to tack it open.

Women with pelvic organ prolapse may have pelvic floor surgery to secure their organs in place, correcting the compression of the urethra.

What to Do If You Cannot Pee

If you have a hard time peeing, see a doctor as soon as possible. Mild cases of urinary hesitancy may improve with physical therapy or medications prescribed by your doctor. Worsening cases of urinary hesitancy—or a complete inability to pee at all—require urgent medical attention.

Left untreated, urinary hesitancy can lead to serious complications such as bladder infections or kidney damage. If you have trouble peeing, see a doctor right away if you have any of the following symptoms:

• Your urinary hesitancy is getting worse over time.
• You cannot pee at all.
• You have bladder pain or pressure.
• You are experiencing recurring bladder infections.
• You develop a fever.