Urinary hesitancy

Home care:

Voiding patterns should be monitored, recorded, and reported to the doctor. Heat applied to the lower abdomen may enhance muscle relaxation and aid urination. Crede's maneuver--massage or pressure over the bladder (lower abdomen above the groin) will sometimes stimulate the bladder to empty.

Otherwise, follow prescribed therapy for treating the underlying cause. Infections may be treated with antibiotics. For bladder infections, drink lots of fluids (particularly fruit juices).

Call your health care provider if:

• there are symptoms of fever, vomiting, back pain or shaking chills.
• there is a problem associated with hesitancy, dribbling, or weak urine stream.
• there is blood in the urine.
• the symptoms persist for 24 hours or continue to recur.
• there is any discharge from the urethra.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting the urinary hesitancy in detail may include:

• time pattern
  • How long has difficulty starting urine flow been noticed?
  • Did it come on gradually?
  • Is it worse in the morning?
  • Is it worse at night?

• quality
  • Is starting the urine flow difficult?
  • Is there decreased force of urine flow?
  • Is dribbling a problem?
  • Is controlling urine a problem?

• aggravating factors
  • What makes it worse?

• relieving factors
  • What helps?
  • Is it helped by applying heat to the lower abdomen?
  • Is it helped by massage or pressure over the bladder?

• other
  • What other symptoms are also present?
    • Is there fever?
    • Is there pain or burning when starting flow of urine?
    • Is there pain or discomfort in the bladder?
    • Is there pain or discomfort in the abdomen?
    • Is there pain or discomfort in the back?
    • What color is the urine?
    • Is any blood noticed?

• medical history
  • Is there any history of:
    • bladder infection?
    • kidney infection?
    • leaking urine?
    • prostate enlargement?
    • prostate infection?

  • Have there been any recent injuries, surgeries, or diagnostic procedures on the pelvis or bladder?
  • Are there problems with constipation?
  • What medications are being taken?

A physical examination will be performed with special attention to the pelvic, rectal, abdominal and lower back regions. The bladder should be palpated to determine the degree of distention. The voiding pattern may be monitored and the bladder palpated frequently to determine distention. Crede's maneuver may be used to start the flow of urine.

Diagnostic tests that may be performed include:

• cystometrography
• voiding cystourethrogram
• urinalysis and culture
• urethral swab for culture
• transrectal ultrasound of the prostate (similar to a transvaginal ultrasound)
• catheterization of the bladder to determine residual urine volume and to obtain urine for culture (a catheterized urine specimen)

Intervention:
If a bacterial infection is present, antibiotics may be prescribed. A surgical procedure may be required to relieve prostate obstruction (see TURP).

After seeing your health care provider:
You may want to add a diagnosis related to urinary hesitancy to your personal medical record.