Difficulty Urinating or Unable to Pass Urine
Difficulty passing urine can develop gradually or occur suddenly. Some men notice that the urine stream becomes weaker, takes longer to start, or stops and starts. Others may feel that the bladder is still full even after urinating, or have a strong urge to urinate but can only pass a small amount each time.
If you suddenly cannot pass urine at all, particularly with increasing lower abdominal pain or swelling, this may be acute urinary retention and requires urgent medical assessment.
What does difficulty urinating feel like?
Urinary difficulty can present in different ways:
- A weak or slow urine stream
- Difficulty starting urination
- Needing to strain or push
- A urine stream that stops and starts
- Taking longer than usual to empty the bladder
- Feeling that the bladder has not emptied completely
- Passing small amounts of urine frequently
- Dribbling after urination
- Waking several times at night to urinate
In more severe cases, you may have a strong urge to urinate but little or no urine comes out.
Why am I having difficulty passing urine?
Enlarged prostate
Benign prostate enlargement (BPH) is a common cause of urinary difficulty in men, particularly with increasing age.
The prostate surrounds part of the urethra. As it enlarges, it can narrow the passage through which urine leaves the bladder.
Symptoms may gradually progress from a slower stream to increasing difficulty emptying the bladder.
Urethral stricture
A urethral stricture is narrowing caused by scar tissue within the urethra.
It may occur following previous urinary procedures, catheterisation, injury or infection. Some men develop a progressively thin or weak urinary stream.
Further assessment may include uroflowmetry, imaging or cystoscopy.
Bladder problems
Sometimes the obstruction is not the only problem.
The bladder muscle must contract effectively to push urine out. Long-standing obstruction, neurological conditions and some other medical conditions can affect bladder function.
When the cause is uncertain, tests such as uroflowmetry, measurement of residual urine or urodynamic testing may help determine how the bladder is functioning.
Urinary stones
A stone within the bladder or urinary tract can occasionally interfere with urine flow.
Other symptoms may include:
- Pain when urinating
- Blood in the urine
- Intermittent urine flow
- Lower abdominal discomfort
- Recurrent urinary infections
Infection or inflammation
A urinary tract infection or inflammation of the prostate can cause swelling and make urination more difficult.
There may also be burning during urination, urinary frequency, pelvic discomfort, fever or chills.
Medicines
Some medicines can make urination more difficult, particularly in men who already have prostate enlargement.
These can include certain:
- Cold and flu medicines
- Antihistamines
- Decongestants
- Antidepressants
- Medicines with anticholinergic effects
Do not stop prescribed medication without discussing it with your doctor.
What if I cannot pass urine at all?
A sudden inability to urinate is called acute urinary retention.
The bladder continues to fill but cannot empty properly. This can cause severe pressure or pain in the lower abdomen.
Seek urgent medical attention if:
- You cannot pass urine despite having a strong urge
- Your lower abdomen becomes increasingly painful or swollen
- Urinary difficulty occurs with fever or chills
- You feel significantly unwell
Acute urinary retention usually requires prompt drainage of the bladder with a urinary catheter.
Once the immediate retention has been relieved, the underlying cause can be investigated.
Does urinary retention always mean I need prostate surgery?
No.
Treatment depends on why the retention occurred and whether normal urination can be restored.
For men with prostate enlargement, medication may sometimes be started followed by a trial without catheter (TWOC) after a period of bladder drainage.
Some men are able to urinate normally again.
Others continue to retain urine or experience repeated episodes. In these situations, treatment of the underlying prostate obstruction may be considered.
How is difficulty urinating investigated?
Assessment usually begins with your symptoms, medical history and examination.
Depending on the situation, investigations may include:
Urine test
To look for infection or blood in the urine.
Uroflowmetry
Measures how quickly urine flows and the pattern of the urinary stream.
Post-void residual urine
An ultrasound can measure how much urine remains in the bladder after urination.
Ultrasound
May assess the bladder, prostate and kidneys, particularly when significant obstruction or urinary retention is suspected.
PSA
A PSA blood test may be considered depending on your age, prostate findings and clinical situation.
Cystoscopy
A thin flexible telescope may be passed through the urethra to examine the urethra and bladder when conditions such as urethral stricture or bladder pathology are suspected.
Urodynamic testing
This may be useful when it is unclear whether symptoms are caused mainly by obstruction or by the way the bladder muscle is functioning.
What happens if an enlarged prostate is causing the blockage?
Treatment depends on the severity of symptoms, prostate anatomy, bladder function and whether complications have developed.
Medication
Medicines may help relax the prostate or reduce its size and can improve urine flow in suitable patients.
Rezum water vapour therapy
Rezum uses controlled water vapour to treat obstructing prostate tissue. It may be considered for selected men with benign prostate enlargement.
Bipolar Plasma TURP
For more significant obstruction, prostate tissue can be removed through the urinary passage to create a wider channel for urine flow.
The appropriate treatment depends on the individual cause and degree of urinary obstruction.
Can I leave a weak urine stream untreated?
Mild urinary symptoms do not always require a procedure.
However, worsening obstruction can sometimes lead to:
- Increasing residual urine in the bladder
- Recurrent urinary tract infections
- Bladder stones
- Acute urinary retention
- Changes to bladder function
- Kidney problems in severe cases
Persistent or worsening difficulty urinating should therefore be assessed rather than judged by the strength of the urine stream alone.
When should I see a urologist?
Consider a urological assessment if you have:
- A progressively weaker urine stream
- Increasing difficulty starting urination
- Persistent straining to urinate
- A feeling that the bladder does not empty properly
- Recurrent urinary infections
- Blood in the urine
- Repeated episodes of urinary retention
- Urinary symptoms that are affecting sleep or daily activities
If you cannot pass urine at all, seek urgent medical attention rather than waiting for a routine appointment.
Frequently Asked Questions
Why do I feel like I need to urinate but cannot pass urine?
This can happen when urine cannot flow out of the bladder normally. In men, common causes include an enlarged prostate, urethral stricture, infection or problems with bladder function. If you suddenly cannot pass urine at all, especially with lower abdominal pain or swelling, seek urgent medical attention.
Is difficulty urinating always caused by an enlarged prostate?
No. An enlarged prostate is a common cause in men, but similar symptoms can occur with urethral stricture, urinary stones, infection, certain medicines or bladder dysfunction. Assessment can help determine the underlying cause.
What should I do if I suddenly cannot urinate?
A sudden inability to pass urine is called acute urinary retention. It usually requires urgent medical assessment and the bladder may need to be drained with a urinary catheter. The cause can then be investigated after the immediate retention has been relieved.
Does a weak urine stream mean my prostate is enlarged?
Not necessarily. Prostate enlargement can reduce urine flow, but a weak stream can also occur with urethral narrowing or reduced bladder muscle function. Uroflowmetry and measurement of urine remaining in the bladder after urination can provide further information.
Can urinary retention damage the kidneys?
Severe or prolonged urinary retention can increase pressure within the urinary system and, in some cases, affect kidney function. This is one reason persistent difficulty emptying the bladder should be assessed.
Will I need surgery if I have urinary retention?
Not everyone with urinary retention requires surgery. Treatment depends on the cause, severity of obstruction, prostate anatomy, bladder function and whether retention recurs. Options may include medication, a trial without catheter or a procedure to relieve the obstruction.
Can an enlarged prostate cause complete urinary blockage?
Yes. Prostate enlargement can sometimes obstruct urine flow enough to cause acute urinary retention. This may occur after gradually worsening urinary symptoms, although some men experience retention relatively suddenly.
Which tests are used for difficulty urinating?
Depending on the symptoms, assessment may include a urine test, uroflowmetry, post-void residual urine measurement, ultrasound, PSA testing, cystoscopy or urodynamic testing. Not every patient requires every test.
Urological Assessment for Difficulty Urinating
Difficulty passing urine can result from prostate enlargement, urethral narrowing, bladder dysfunction or other urinary conditions.
A urological assessment can help identify whether there is significant obstruction, determine how well the bladder is emptying, and guide whether monitoring, medication or a procedure should be considered.