Do you also have difficulty urinating? (Urinary Hesitancy) Let's talk about this!

Do you sometimes have to wait a while for your urine to come out? Or do you suddenly stop while urinating , and only a little bit comes out when you try again? If this has happened to you, then you may also have the condition we are talking about today, 'difficulty urinating '. This is medically known as `(Urinary Hesitancy)`. Let's talk about this in more detail.

What is this difficulty in urinating ? (Urinary Hesitancy in simple terms)

Simply put, `(Urinary Hesitancy)` means that you have difficulty urinating (i.e. passing urine). This means that you may have difficulty starting to urinate , or you may have difficulty continuing to urinate at a steady, steady pace. Sometimes, you may stop urinating even though you still want to urinate .

This can really happen to anyone, but if you're a man, you're a little more likely to experience this condition.

Doctors use the word "hesitancy" to refer to either difficulty starting to urinate or difficulty maintaining the flow of urine .

What symptoms do you experience in this situation?

The main symptoms of ``Urinary Hesitancy'' are difficulty starting to urinate and stopping urination before the bladder is completely empty. In addition, other symptoms may occur.

• Feeling like you need to urinate , but not being able to urinate .
• The urge to urinate .
• Feeling like your urine is passing very slowly, or like a thin stream of urine .
• Dribbling, even after you've finished urinating .

Other symptoms besides difficulty urinating

Sometimes this condition of ``Urinary Hesitancy`` can lead to ``Urinary Retention`` or even the inability to urinate . In this case, it can be accompanied by symptoms such as:

• Feeling pain in the lower abdomen.
• Feeling like your stomach is bloated.
• Leaking a little urine without realizing it (also called ``Urinary Incontinence'').

Why is this happening? What are the reasons?

There are several reasons why it can be difficult to urinate . Let's take a look at what they are.

The most common cause affecting men

The most common cause for this is an enlarged prostate gland (Benign Prostatic Hyperplasia - BPH).. This is most common in men over the age of 60. The prostate is a small gland that only men have. It is located below the bladder, surrounding the urethra. So when it grows, it can compress the urethra and obstruct the flow of urine .

Other common reasons

In addition, there may be several other reasons:

• Urinary Tract Infections (UTIs) or Bladder Infections: These are very common among us.
• Prostatitis: This is a condition in which the prostate gland becomes swollen and infected.
• Scarring and narrowing of the urethra (Urethral Stricture): The urethra can become narrowed from the inside due to an accident or infection.
• Severe constipation: When constipation is severe, it can put pressure on the bladder and affect urination .
• Certain medications: For example, some antidepressants (Tricyclic Antidepressants), medications for urinary incontinence, and some medications for colds and allergies can also cause this.
• Inability to relax the pelvic floor muscles properly: These muscles need to relax when urinating . If they don't relax properly, it can be difficult to urinate (Pelvic Floor Dysfunction).
• Nervous system diseases: Nerve diseases in which the signals from the brain to the bladder do not function properly. For example, stroke, multiple sclerosis (MS), or diabetes-related neuropathy.
• Pelvic Organ Prolapse: When the muscles in the pelvic cavity weaken, organs such as the bladder can drop down. This can also affect urination .

Who is most likely to be affected by this situation?

As mentioned earlier, this can happen to anyone, at any age. However, it is most common in men over 60 years of age who have an enlarged prostate (BPH).

How does a doctor recognize this?

When you tell your family doctor (Primary Care Physician - PCP) that you are having difficulty urinating , he or she will ask you about your symptoms, take your health history, and perform a physical exam.

Questions to ask you

The doctor may ask questions like these:

• How long have you had this difficulty urinating ?
• Do you feel like you're urinating more slowly than usual?
• Did these symptoms come on suddenly, or did they gradually increase?
• Is there any medicine you can take from the pharmacy to get relief from this?
• Have you ever felt like this difficulty increases when you eat certain foods or do certain things?

Based on your answers to these questions, the doctor can get a good idea of ​​the situation.

What tests are performed?

After that, the doctor may order some tests to confirm the condition of ``Urinary Hesitancy'' and find the cause.

• Urodynamic Tests: This is a combination of several tests. These look at:
• How much do you urinate ?
• How is your urination speed and strength?
• How is the pressure inside your bladder?
• Imaging tests: For example, an ultrasound scan or a CT scan may be ordered. These can look at how your bladder fills and empties, and can also check the size of your prostate. Sometimes a cystoscopy, which involves inserting a small camera through your urethra to look inside your bladder, may be done.
• Digital Rectal Exam: This involves manually examining the size of the prostate gland.
• Urinalysis: A sample of your urine is taken and the contents (microscopic indicators, chemicals) are tested.
• Urine Culture: This test is done to check for a bacterial infection in the urine .

What are the treatments for difficulty urinating ?

The treatment for urinary hesitancy depends on the cause and whether you have any other medical conditions. Your doctor may suggest the following treatments:

• Bladder Retraining / Timed Voiding
• Pelvic Floor Physical Therapy
• Medicines
• Surgery
• Sacral Nerve Stimulation / Sacral Neuromodulation

Let's look at each of these in a little more detail.

Bladder training (Timed Voiding)

This involves retraining your bladder muscles. This involves going to urinate at regular intervals (usually every two hours). This is done by emptying your bladder before it fills up. Even if you don't feel like urinating , you should try to go at regular intervals.

Pelvic Floor Physical Therapy

This involves teaching you exercises that will help you relax the muscles in your pelvic floor. When these muscles are properly relaxed, it is easier to urinate .

Medicines

The doctor may give you medications to stop the prostate from growing or to shrink the existing one (e.g. Dutasteride, Finasteride). Or he may give you medications to relax the muscles of the bladder and prostate (Alpha-blockers). If there is an infection, he will give you antibiotics.

Surgery

If the urethra is narrowed, surgery can be done to widen it (Urethral Dilation) or reconstruct it (Urethral Reconstruction). If the prostate gland is enlarged due to BPH, there are various surgical procedures to remove the excess tissue. Some are simple and can be done in the doctor's office. Others are surgeries that use electrical or laser energy. Sometimes a surgery to remove part or all of the prostate gland (Prostatectomy) can be done. If the pelvic organs have dropped (Pelvic Organ Prolapse), there are surgeries to put the organs back in place and support them to prevent them from dropping again.

Sacral Nerve Stimulation

In this, a small device called a ``Neurostimulator'' is implanted under the skin near your buttocks. This device sends very fine electrical impulses near your sacral nerve to stimulate the bladder muscles.

What things can you do at home?

In some cases, talking to your doctor and doing simple things at home can help relieve this condition (Urinary Hesitancy).

• Heat: Things like taking a hot bath or placing a hot water bottle or heating pad on your lower abdomen can relax the pelvic floor muscles, making it easier to urinate .
• Massage: While urinating , gently massaging your lower abdomen (where the bladder is) with your hands or applying gentle pressure can help increase the speed and force of your urine flow.
• Stool Softeners or Laxatives: If you have constipation, taking appropriate foods, drinks, and medications (in the laxative category) to keep your bowels moving properly will also help with bladder function.

The most important thing is that before trying these home treatments, you should definitely consult a doctor and only do them if they say "it's safe for you to do these."

The benefits of keeping a 'bladder diary'

Your doctor may also ask you to keep a "bladder diary," a book that records things related to your bladder. In it, you should record things like:

• The amount of water and fluids you drink per day.
• The amount of urine you urinate (measure it if possible).
• The speed of urination (such as whether it is going well or slowly).
• How long does it take to urinate ?
• How many times do you urinate a day?
• In addition, you may experience other symptoms.

By keeping a diary like this, both you and your doctor can gain a better understanding of this situation.

How quickly will I recover after treatment?

This really depends on the cause of your urinary hesitancy and the treatment you are prescribed.

• Pelvic Floor Physical Therapy can take several weeks to see results.
• Muscle relaxants can take several hours to start working.
• After the sacral nerve stimulation device is implanted, it may take several weeks to see results.
• It can take several months to fully recover after surgery .

Can this situation be prevented?

We cannot prevent all causes of `(Urinary Hesitancy)`. However, maintaining good urinary habits and avoiding constipation can help to some extent. That is, you should urinate every few hours, do not hold your urine in. Also, you should have a good, gentle bowel movement once a day.

What are the best times to see a doctor?

See a doctor as soon as you notice that you are having difficulty urinating or that your urine flow is slower than usual. Don't ignore your symptoms or assume that "it will go away on its own." It can be embarrassing to talk about urinating , but it's important to get a new symptom checked out right away.

Do you need to go to the Emergency Treatment Unit (ETU) ?

If you feel a strong urge to urinate but can't pass any urine , especially if it's accompanied by pain in your lower abdomen or genital area, go to the Emergency Room (ER) immediately. This is something you shouldn't delay.

Important questions to ask the doctor

When you go to see the doctor, don't forget to ask questions like these:

• What do you think is the reason for my difficulty urinating , doctor?
• What tests are recommended for me to have?
• Do I need to have any additional tests?
• What treatment is recommended for me?
• Will my difficulty urinating ever completely improve?

Finally, what to remember (Take-Home Message)

Although it's not something we all talk about every day, when you have a good amount of urine , it's so healthy to completely empty your bladder and urinate , right? But at the same time, think about how annoying and embarrassing it is when you can't urinate comfortably and completely and something interferes. That's what is called `(Urinary Hesitancy)`.

If simple home remedies don't help your symptoms, don't be shy about talking to a doctor. There's nothing wrong with taking care of your health, and there's nothing to be ashamed of. So, if you have a problem, get the help you need.

` Urinary retention, difficulty urinating , Urinary Hesitancy, BPH, Prostate, Urinary tract infections, Urinary symptoms