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Poor urine flow

Poor (weak) urine flow

Table of Contents

Poor urine flow is when urine falls on your feet or not far away. In this case, you cannot hold a regular urinary stream during urination. In other words, the pressure of the urine stream is low.

Quite often, weak urine flow accompanies trouble starting to urinate. We call it hesitancy.

Poor urine stream can keep you in the bathroom for minutes. The dribbling at the end of urination is quite frequent. Your underwear and pants may get wet and smell bad.

Why do I have a weak urinary flow? What causes a poor urinary stream? Moreover, how can I improve, treat or fix my situation?

I will try to answer all of your questions.

Causes of poor urine flow

Weak urinary stream occurs in the following situations:

  1. In the urethral obstruction, the urethra or the tube carrying the urine out is narrow at some point; the urine flow decreases its speed in the narrowed point of the urethra; then the bladder makes extra efforts to enhance its contractility to push the urine to pass through the urethral narrowing;
  2. Bladder failure is a condition where the bladder is weak and cannot contract efficiently to push the urine out of the body; we call it bladder underactivity. With bladder failure the urine flows out at a lower speed because the pressure generated into the bladder by low contraction is insufficient;
  3. The combination of bladder failure and urethral obstruction is a common condition when someone has had a urethral obstruction for a long time. In this case, the bladder become weak because of muscular fatigue, muscle degeneration, and substitution with fibrous tissue.

Obstruction

  • Prostate disease (prostatitisprostate enlargement, prostate cancer): bladder outlet obstruction;
  • Urethra diseases (urethral stricture): obstruction of the tube carrying the urine out of the bladder;
  • Diffuse genital herpes with swollen and obstruction of the urethral outlet
  • Urethral stones: Usually, stones are expulsed through the urethra, but sometimes they can be stuck in the urethra, causing obstruction
  • Endoscopic procedures can cause inflammation, swelling, and obstruction of the urethra
  • medications, such as decongestants, cause contraction of the bladder outlet and obstruction
  • Bowel constipation

Insufficient bladder contraction

  • bladder muscle disorders
  • anesthesia from surgery
  • nerve damage from accidents, strokes, diabetes, brain damage, or surgery
  • Diffuse genital herpes by affecting the sacral nerves supplying the bladder and the other pelvic organs.

Poor urine flow at night or in the morning

A weak urinary stream can sporadically happen when you start urinating and you have an overfull bladder. It typically occurs in the morning, when your bladder has overfilled during the night. Then, urination is hard to start (hesitancy), and you cannot hold a regular stream.

Causes of the weak urine stream in men

A benign, enlarged prostate is one common cause of slow urine flow in men. It is the most common cause in older men. In addition, young males may experience an inflammation of the prostate called prostatitis. In these situations, the prostate increases its volume and obstructs the urethra. Consequently, urination becomes complicated and slow.

Frequent urination and poor ejaculation often accompany poor urinary stream in prostate diseases.

Causes of the weak urine stream in women

Poor urinary stream, or hesitancy, is less frequent in women. This symptom is most likely to develop after childbirth or postpartum and is related to trauma to the bladder’s nerves. The risk factors are:

  • the prolonged second stage of labor;
  • episiotomy;
  • perineal tearing;
  • use of forceps or vacuum during childbirth;
  • epidural use;
  • baby weighing over 4000 grams.

Urinary tract infections and herpes genitalis are other possible causes of low urine flow and hesitancy in women.

Poor urine flow during pregnancy

During pregnancy, you are more likely to have frequent urination rather than poor urinary flow. Despite some beliefs, poor urine flow cannot be considered a sign of early pregnancy.

Weak urine stream in postmenopausal

Postmenopausal women may have a weak urinary stream because of the under-activity of the bladder muscle. The bladder contracts slower, and the urine flow is weak.

Causes of poor urinary flow after surgery

Immediate after cystoscopy, endoscopic prostate resection (TURP), or prostate surgery (Radical prostatectomy), reduced urine flow is typical, and it is due to inflammation and swelling of the urethra after the surgical trauma. The obstruction is usually transitory. After days, the urine flow will improve along with the inflammation recovery. If the poor urinary stream occurs after weeks to a few months, most likely the obstruction is due to a urethral scar, and we have to consider the further procedure.

Poor urinary flow after other surgeries, like inguinal hernia surgery, may be related to transitory bladder hypo-function because of epidural anesthesia.

Other pelvis surgeries like hysterectomy or low anterior colon resection may be the reason for hesitancy and low urinary flow. It may be due to accidental nerve damage during the operation.

In all cases, the patient needs bladder catheterization (temporary or permanent) to void the bladder and preserve kidney function.

Alcohol and weak urinary flow

Alcohol causes dilatation of the veins. The prostate and the bladder neck are widely surrounded by large veins draining the blood from those organs. The more the veins dilate, the less efficient the blood drainage from the prostate and the bladder neck is. It results in blood congestion, prostate swelling, and contraction of the bladder and neck. Consequently, the urinary flow will be weak.

Weak urine flow along with other symptoms

Weak urinary flow may come not alone. It may occur along with painful urination and a burning sensation in case of UTI.

When weak urine flow comes with frequent urination, it is a sign of lower urinary tract obstruction like prostate enlargement or urethral stricture. In these cases, there may also be poor ejaculation.

If a stone gets stuck in the urethra, the urine flow will be in scattered and possibly painful drops.

Fever and poor urine stream are always urgent and sometimes a real emergency.

Poor urine flow and diabetes

One of the complications of diabetes is bladder underactivity related to damage to its nerves. The nerves innervating the bladder are commonly affected over the years, especially in uncontrolled diabetes. Consequently, the nerve signal for contraction is less efficient, and the bladder contraction is weak. However, diabetes reduces the muscle in the bladder wall that contracts less efficiently. All these situations are caused by weak urine flow.

How to cure poor urine flow

Since there are several reasons for weak urine flow, we cannot treat it without a correct diagnosis. The urologist will guide you through the diagnostic steps which usually include:

  • urine analysis;
  • blood work;
  • US scan;
  • Uroflowmetry;
  • Cysto-urethrography;
  • Urethra-cystoscopy.

Emergency

A weak urine stream, mainly if associated with other symptoms (above all fever), is always a good reason to see a doctor.

Home remedies

I strongly contraindicate home remedies for weak urine stream without seeing a doctor first.

External resources

European Association of Urology