Have trouble initiating urination or maintaining a flow? You might be suffering from urinary hesitancy, a condition that affects both sexes but is more common in men. Dr Jonathan Chong of DTAP Clinic tells us about its common causes, treatment options and potential complications.
A common cause is benign prostatic hyperplasia.
Benign enlargement of the prostate occurs when the prostate gland is enlarged but not cancerous. The prostate goes through two main growth periods as a man ages: the first during puberty, when the prostate doubles in size; and the second around age 25, which continues during most of your life. Benign prostatic hyperplasia often occurs during the second growth phase.
Another common cause is an overactive bladder, which results in a frequent and sudden urge to urinate that may be difficult to control. However, although a common condition among older adults, it should be noted that an overactive bladder isn't a typical part of ageing.
Urinary hesitancy belongs to a group of symptoms often referred to as “lower urinary tract symptoms”.
They include urgency, increased frequency, needing to wake one or more times a night to void, a slow urinary stream, an intermittent urinary stream and discomfort when passing urine.
The prevalence of these symptoms increases with age.
In a survey involving more than 5,000 males aged 65 and above conducted in the United States, 46 percent of the men reported moderate to severe symptoms.
Treatment entails both behavioural modification and medication.
Behavioural modification is really making lifestyle changes—these include avoiding fluids before going to bed and reducing the consumption of caffeine and alcohol as these beverages can have a diuretic effect. Pelvic floor muscle exercises may also help improve symptoms.
The exact medication used would be determined by the underlying cause of the urinary hesitancy and other associated lower urinary tract symptoms. For example, when treating benign prostatic hyperplasia, medication to relax the muscles at the bladder neck/prostate and to reduce the size of the prostate gland may be prescribed. Conversely, when treating an overactive bladder, medication to reduce bladder wall muscle contractions may be used instead.
Surgical treatment may be considered if the combination of lifestyle changes and medication is unable to alleviate the symptoms.
If left untreated, urine hesitancy can significantly impact your quality of life.
Potential complications include an acute retention of urine, which is the inability to voluntarily pass urine and that over time can bring about an increased risk of urinary tract infections, the formation of bladder stones and possibly even kidney damage.