Urinary hesitancy
Urinary hesitancy: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Urinary hesitancy—difficulty starting a urine stream generally followed by a decrease in the force of the stream—can result from a urinary tract infection (UTI), a partial lower urinary tract obstruction, a neuromuscular disorder, or use of certain drugs. Occurring at all ages and in both sexes, it’s most common in older men with prostatic enlargement. It also occurs in women with gravid uterus, tumors in the reproductive system (such as uterine fibroids), or ovarian, uterine, or vaginal cancer. Hesitancy usually arises gradually, commonly going unnoticed until urine retention causes bladder distention and discomfort.
History and physical examination
Ask the patient when he first noticed hesitancy and if he has ever had the problem before. Ask about other urinary problems, especially reduced force or interruption of the urine stream. Ask if he has ever been treated for a prostate problem, a UTI, or a urinary tract obstruction. Obtain a drug history.
Inspect the patient’s urethral meatus for inflammation, discharge, and other abnormalities. Examine the anal sphincter and test sensation in the perineum. Obtain a clean-catch urine specimen for urinalysis and culture and sensitivity tests. A male patient requires prostate gland palpation. A female patient requires a gynecologic examination.
Medical causes
Benign prostatic hyperplasia
Signs and symptoms of this disorder depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of the urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream, and occasionally urine retention. As the obstruction increases, the patient may develop urinary frequency, nocturia, urinary overflow, incontinence, bladder distention and, possibly, hematuria.
Prostate cancer
In advanced cancer, urinary hesitancy may occur along with frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from urine retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
UTI
Urinary hesitancy may be associated with UTIs. Characteristic urinary changes include frequency, dysuria, nocturia, cloudy urine and, possibly, hematuria. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy also may occur in patients recovering from general anesthesia.
Special considerations
Monitor the patient’s voiding pattern, and palpate the abdomen frequently for bladder distention. Apply local heat to the perineum or the abdomen to enhance muscle relaxation and aid urination. Also, teach the patient how to perform a clean, intermittent self-catheterization. (See How to catheterize yourself, page 782.) Prepare the patient for tests, such as cystometrography or cystourethrography.
Pediatric pointers
The most common cause of urinary obstruction in male infants is posterior strictures. Infants with this problem may have a less forceful urine stream and may also exhibit a fever due to UTI, failure to thrive, and a palpable bladder.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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