What does weak stream mean?
Normal urination begins without effort, proceeds in a continuous stream and ends with complete emptying. If the pressure is reduced, other symptoms are usually added to the complaints: you have to wait for it to start, push, the stream is interrupted or splits, after urination there is a feeling of incomplete emptying, and you have to get up at night. Doctors combine these complaints into a group of lower urinary tract symptoms and score them using special questionnaires. A slow increase over months is typical for prostate hyperplasia; a sharp deterioration over days is a reason for an urgent examination.
- Waiting a long time to start urinating
- The need to push
- Intermittent or split stream
- Feeling of incomplete emptying
- Dribbling after urination
- Getting up to go to the toilet at night
Reasons for men
With age, the prostate gland enlarges and compresses the urethra - this is benign hyperplasia, the most common cause of weak stream after 50 years. The second most important mechanism is narrowing of the urethra, often scarring, after injuries, catheterizations, endoscopic operations or infections. Chronic prostatitis causes swelling and spasm in the area of the bladder neck. Less common are urethral stone, bladder neck sclerosis and prostate cancer. Separately, situations are considered when the bladder muscle itself has weakened: with prolonged obstruction, diabetes mellitus and neurological diseases.
- Benign prostatic hyperplasia
- Urethral stricture
- Chronic prostatitis
- Bladder neck sclerosis
- Prostate cancer
- Bladder muscle weakness in diabetes and nervous system diseases
Reasons for women
In women, the urethra is short, so obstruction is less common, but it still happens. The stream is weakened by pronounced prolapse of the anterior wall of the vagina and uterus, when the bladder is displaced and bent, scarring after surgery for urinary incontinence, large fibroids and pelvic formations. Neurological causes contribute - multiple sclerosis, consequences of spinal injury, diabetic neuropathy, as well as the habit of enduring and overstretching the bladder for a long time. Sometimes difficulties with starting to urinate are associated with spasm of the pelvic floor muscles and psychological stress.
- Prolapse of the walls of the vagina and uterus
- Scar changes after urethral surgery
- Volumetric formations of the pelvis
- Neurological diseases and diabetic neuropathy
- Pelvic floor muscle spasm
- Chronic bladder overdistension
What examinations are needed
The key study is uroflowmetry: the patient urinates into a special device that builds a curve and calculates the maximum flow rate. Immediately after this, residual urine is measured by ultrasound, and the volume of the prostate, the condition of the bladder wall and kidneys are also assessed. A general urine test excludes infection and blood; culture is needed if inflammation is suspected. For men over 50 years old, and with a family history earlier, PSA is determined. If narrowing of the urethra is suspected, urethrography or urethroscopy is performed; for neurological reasons, a urodynamic study is performed.
- Bleeding Diary and Symptom Questionnaire
- Uroflowmetry
- Ultrasound of the bladder and prostate with residual urine
- General urine analysis and culture according to indications
- Blood PSA in men
- Urethrography or urethroscopy if stricture is suspected
Treatment and prevention
Tactics depend on the cause and extent of the violation. For moderate prostate hyperplasia, drugs that relax the smooth muscles of the bladder neck and drugs that reduce the volume of the gland are prescribed; the effect is assessed after several months. In case of a large volume of residual urine, repeated infections, stones and episodes of retention, surgery is discussed - endoscopic removal or laser enucleation of prostate tissue. Urethral stricture is treated surgically, prostatitis is treated according to a urologist’s scheme. Women with prolapse are offered pelvic floor exercises, a pessary or plastic surgery. It is useful not to wait too long, limit fluids and caffeine at night.
- Drug therapy for prostate hyperplasia
- Endoscopic or laser prostate surgery
- Surgical treatment of urethral stricture
- Treatment of prostatitis and urinary tract infections
- Exercises for the pelvic floor muscles and correction of prolapse
- Do not tolerate too long, limit caffeine and alcohol in the evening
