What is urinary hesitancy: symptoms, causes, and how to get relief

Ever found yourself in the bathroom, ready to pee, only to wonder, “Where’s the whoosh?” Maybe it’s tough to get started, your urine stream is slow or weak, you feel like you haven’t fully emptied your bladder, or you notice some dribbling at the end. A quick bathroom break turns into a frustrating waiting game — when your brain says “go,” but your body hits pause. 

This is urinary hesitancy: a common, often-overlooked condition that can affect anyone. It’s not something you just have to deal with: Gentle pelvic floor stretches, targeted exercises, and select lifestyle changes may help support healthier bladder function and restore a smoother flow.

Here, learn more about what causes urinary hesitancy, plus practical strategies to manage and treat it — including exercise tips from our Hinge Health physical therapists. 

What is urinary hesitancy?

Urinary hesitancy is when you have trouble starting to urinate or keeping your urine stream going once you begin. Sometimes your flow may be slow or weak, or may stop before you feel fully empty. While urinary hesitancy can affect anyone, it’s more common in people with a prostate, often related to age-related changes in the prostate gland.

Urinary hesitancy is related to, but not the same as, incomplete bladder emptying (sometimes called urinary retention). Incomplete bladder emptying is when you aren’t able to fully empty your bladder, which can leave you with a chronic sense of fullness, discomfort, or the need to urinate again soon after. When you can’t urinate at all, this kind of complete retention is a medical emergency.

Urinary hesitancy means you eventually do pass urine, though it may be delayed or with a weak stream. Both urinary hesitancy and incomplete emptying can leave you feeling like your bladder isn’t fully emptied. If urine remains in the bladder for too long — a situation sometimes called urinary stasis — it can increase the risk of urinary tract infections or other complications.

Urinary hesitancy is also different from other common bladder issues:

• Urinary incontinence: involuntary leakage of urine

• Urinary urgency: sudden, strong need to urinate

• Urinary frequency: urinating more often than typical (every two to four hours; six to eight times a day), especially with low volumes

You may experience one or more of these alongside hesitancy or incomplete emptying, especially in conditions like overactive bladder (OAB) or with urinary hesitancy due to nerve or muscle issues.

Causes of urinary hesitancy

Urinary hesitancy can result from a range of issues that affect the function of how your pelvic floor muscles, urethra, nerves, or urinary tract function, as well as certain medications you may be taking. Below are common causes:

• Tight pelvic floor muscles. Muscles in the pelvic floor help control urination. They need to relax to allow urine to flow out of the bladder, explains Karla Arevalo-Alas, PT, DPT, a Hinge Health physical therapist. If pelvic floor muscles are tense (hypertonic), they can interfere with urine flow.

• Urethra issues. The urethra is the thin tube that carries urine from the bladder out of the body. Scar tissue can form in the urethra following injury, surgery, or infections (such as sexually transmitted infections). If this scar tissue causes the urethra to narrow (urethral stricture), it can block or slow the flow of urine and make it harder to start or maintain a urine stream.

• Neurological issues. Conditions that affect the nerves — like diabetes, stroke, multiple sclerosis, or spinal cord injuries — can disrupt the signals between your brain, bladder, and pelvic floor, leading to hesitancy.

• Urinary tract infections (UTIs). Infections can cause swelling, pain, or irritation in the urinary tract, making it harder to urinate comfortably.

• Certain medications. Some medications — including opioid pain relievers, antihistamines, decongestants, and certain antidepressants — can interfere with bladder function and make urination more difficult.

Urinary hesitancy can have different causes depending on anatomical differences and common health concerns. Here are a few examples:

In people with male anatomy:

• Benign prostatic hyperplasia (BPH). This is the most common cause of urinary hesitancy in people with male anatomy. BPH causes the prostate, which sits just below the bladder and surrounds the urethra, to grow larger and press on the urethra, making it harder to start or keep a urine stream.

• Prostate infection (prostatitis). This is an infection that causes the prostate gland to become swollen and inflamed. The swelling can lead to pain and irritation, and may also press on the urethra, blocking or narrowing the flow of urine and causing hesitancy.

In people with female anatomy:

• Pelvic organ prolapse. When the muscles and tissues that support the pelvic organs become weak, organs like the bladder or rectum can drop out of place and press on the urethra, making it harder to urinate. The most common type of prolapse, called cystocele, is when the bladder drops down and presses into the front of the vagina. This can compress the urethra, and cause urinary hesitancy. Rectocele, or when the rectum bulges into the back of the vaginal wall, may lead to urinary hesitancy as well.

• Pregnancy and childbirth. Body changes during pregnancy and delivery can strain and weaken the bladder and pelvic floor muscles, making it harder for them to work together to fully empty the bladder. Normal urination requires the bladder’s muscular wall (the detrusor) to contract and the pelvic floor muscles to relax at the same time, allowing urine to flow out. Nerve changes or injury during childbirth, as well as hormonal shifts and temporary swelling, can further disrupt this process and increase the risk of urinary hesitancy.

• Gynecological surgeries. Surgery on the reproductive organs — such as hysterectomy (removal of the uterus), pelvic organ prolapse repair, fibroid removal (myomectomy), sling procedures for urinary incontinence, or surgery for endometriosis — can lead to changes in pelvic floor muscle function or cause scar tissue near the urethra, affecting urine flow.

Symptoms of urinary hesitancy

Urinary hesitancy symptoms often involve changes in how easily or completely you’re able to urinate. Common symptoms include:

• Difficulty starting urination: You may stand or sit for a while before your urine stream begins.

• Straining to pee: You might feel the need to push or strain to get the flow going.

• Slow or weak urine stream: Your stream may be less forceful than usual, or take longer to finish.

• Dribbling of urine: Urine may trickle out slowly at the end, instead of stopping sharply.

• Feeling like you can’t completely empty your bladder: After urinating, you may still feel as though you still need to go, or you didn’t quite empty your bladder fully.

When to see a doctor

Urinary hesitancy often improves with treatment. However, you should contact your healthcare provider if you experience any of the following:

• Inability to urinate at all (complete urinary retention)

• Severe or sudden lower abdominal pain or bladder pain

• Visible blood in your urine (hematuria)

• Fever and chills (may indicate an infection)

• Nausea and vomiting (along with urinary symptoms)

• Confusion or disorientation (especially in older adults)

• New onset of urinary hesitancy after prostate surgery or other procedures

• Any symptoms of a urinary tract infection (UTI) — such as burning with urination, foul-smelling urine, or cloudy urine — especially if combined with hesitancy

Treatments for urinary hesitancy

Treating urinary hesitancy depends on the underlying contributors to your symptoms. Your healthcare provider may recommend pelvic floor physical therapy and targeted exercises, bladder training, medication to treat infections or other conditions contributing to symptoms, and in some cases, surgery. Here’s a closer look at urinary hesitancy treatments:

Pelvic floor physical therapy

Physical therapy (PT) and targeted exercises are a key way to treat urinary hesitancy caused by tight pelvic floor muscles. Pelvic floor muscles need to be able to tighten (contract) and fully release (relax) to function properly. When pelvic floor muscles stay contracted, spasm, or have difficulty relaxing, it can lead to urinary hesitancy and other symptoms. 

Targeted exercises can help stretch and relax pelvic floor muscles to improve urine flow. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. During physical therapy, a PT can assess you, help you modify activities that contribute to urinary problems, and empower you with tools and tips for better bladder function. Recommendations may include practicing healthy bladder habits or trying relaxation techniques.

Pelvic health physical therapists can be seen in person or, for those who qualify, through a program like Hinge Health with access to a physical therapist via telehealth/video visit. (See examples of pelvic floor exercises below.)

Bladder training

These are techniques that can help you train the muscles that control your bladder. While bladder training is most often used for people who urinate more frequently than “normal” (which is about seven times per day with two to four hours in between), it can also help manage urinary hesitancy. “Training the muscles to relax and contract when appropriate can help reduce urinary hesitancy symptoms,” says Dr. Arevalo-Alas. Here’s how to do bladder training:

1. Set an interval goal. Decide on a target amount of time you want to wait between bathroom visits (say, two hours between trips to the bathroom).

2. Make a schedule. Plan out and write down the actual times you’ll go to the bathroom based on your interval goal. For example, if you wake up at 7:00 a.m. and choose a two-hour interval, you’d set bathroom times at 7:00, 9:00, 11:00, and so on. Having a schedule helps keep you accountable and makes it easier to track your progress over time.

3. Practice urge suppression if you feel the urge to urinate before your scheduled time. Delaying even five minutes can help your bladder learn to wait to empty.

4. Gradually adjust the interval between bathroom breaks until you reach three to four hours between trips.

Medications

Your healthcare provider may prescribe medications to treat underlying conditions, such as antibiotics to treat a urinary tract or prostate infection. People with an enlarged prostate may be prescribed medicine to help stop the prostate growth.

Surgery

Depending on the condition causing your urinary hesitancy, surgery may be considered to treat a narrow urethra, treat pelvic organ prolapse, or remove a prostate blockage.

These exercises target specific muscles and functions that support healthy urination and can help manage urinary hesitancy. Diaphragmatic breathing eases pelvic floor tension and promotes relaxation, while the kneeling hip adductor stretch and happy baby pose help release tightness in the hips and inner thighs, areas closely connected to bladder control. Reverse Kegels train you to consciously relax your pelvic floor muscles, which is especially helpful if tension or spasms are making it hard to urinate. Pelvic tilts and cat cow stretches boost mobility and flexibility in the pelvis and lower back, aiding overall coordination and relaxation of the urinary system. Consistently practicing these exercises can help restore optimal pelvic floor function, reduce urinary hesitancy symptoms, and make trips to the bathroom feel easier and more natural.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Tips to manage urinary hesitancy

There are several simple lifestyle and self-care strategies — such as healthy bathroom habits, warm baths, pelvic myofascial release, and relaxation techniques — that can help manage urinary hesitancy and support better bladder function. Here’s more about each option:

Practice healthy bathroom habits

Making a few simple changes to your bathroom routine can relieve stress on your bladder and pelvic floor. Consider the following tips:

• Aim to urinate every two to four hours. Avoid going “just in case” too early or waiting too long when you really need to go — both can be hard on your bladder. Try to listen to your body’s natural cues and avoid either extreme.

• Try not to push or strain to empty your bladder. Straining can put stress on your pelvic floor muscles and contribute to hesitancy symptoms.

• Choose a relaxed position when you urinate. If you sit, make sure you’re fully supported — this helps your pelvic floor muscles relax, supports a steady urine stream, and allows your bladder to empty completely. Avoid hovering over the toilet seat, as it can make it harder for your bladder to empty completely.

Take a warm bath

Soaking in warm water can help relax tense pelvic floor muscles, promote an overall sense of calm, and ease pelvic discomfort or tension that may be contributing to urinary symptoms.

Consider pelvic myofascial release therapy

Also known as trigger point therapy, myofascial release is a type of gentle massage that helps release tightness or restrictions in the fascia, or connective tissue that surrounds and supports the muscles. This technique can include working on muscles such as the adductors (inner thighs), abdomen, and hip flexors, as well as the pelvic floor muscles themselves. Applying sustained pressure to trigger points, or knots, in these areas — including the perineum (the area between the anus and vagina or the anus and scrotum) — with a small yoga or tennis ball can help release tension in tight pelvic muscles.

Try relaxation techniques

Deep breathing exercises and progressive muscle relaxation can help lower overall stress, ease muscle tension, and promote pelvic floor relaxation. Regular use of relaxation techniques can help your body adopt healthier restroom habits and reduce the anxiety that may sometimes accompany urinary symptoms.

What should I do if I can't urinate?

If you are suddenly unable to urinate, seek emergency medical treatment. This may be a sign of acute urinary retention — a serious condition in which you are unable to urinate even though you have a full bladder. Other signs of acute urinary retention include:

• Pain — often severe — in your lower abdomen

• Urgent need to urinate

• Swelling of your lower abdomen

PT tip: Kegels are not for everyone

Kegel exercises can be helpful for pelvic health, but they’re not always the right choice, says Dr. Arevalo-Alas. “If you have trouble peeing or having a bowel movement, your pelvic floor muscles might be too tight,” she explains. “Doing standard Kegels could actually make those symptoms worse.” Instead, try exercises that focus on relaxing your pelvic floor (such as reverse Kegels) to help with hesitancy.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Arnold, J. J., Hehn, L. E., & Klein, D. A. (2016). Common Questions About Recurrent Urinary Tract Infections in Women. American Family Physician, 93(7), 560–569. https://www.aafp.org/pubs/afp/issues/2016/0401/p560.html

2. Dougherty, J. M., & Rawla, P. (2020). Female Urinary Retention. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538497/

3. Grimes, W. R., & Stratton, M. (2023, June 26). Pelvic floor dysfunction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559246/

4. Jenkins, S. (2021, June 28). Weak Urine Stream? It Could Be Urinary Hesitancy. - National Association For Continence. National Association for Continence. https://nafc.org/bhealth-blog/weak-urine-stream-it-could-be-urinary-hesitancy/

5. National Institute of Diabetes and Digestive and Kidney Diseases. (2019, December). Definition & facts of urinary retention. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention/definition-facts