In addition to leaking, why do I have to go to the bathroom more often (urgency and frequency)? Why does almost nothing come out when I get there (hesitancy)?
There are many causes for urinary frequency, hesitancy and urgency. Although they may seem to be opposing symptoms, frequent voiding and urinary hesitancy may actually drive each other.
Regarding urgency/frequency: When the bladder is emptied too often (or not enough), the bladder itself may become less compliant. That compliance, or flexibility within the bladder walls, helps define when the body senses urgency. To clarify: the bladder is really a small muscular sack that stretches as it fills with urine. It needs to be stretched to a certain point to trigger urgency (correlating with bladder contraction). If the bladder is emptied too often (or conversely, not enough), then the ability of the bladder to register that “critical point” is lessened. The body will send signals that it is “time to go” by starting bladder contractions at inappropriate times, either before necessary or way too late. The result may become frequent urinary urges.
Regarding hesitancy: Since the bladder contracts when it should not, it also relaxes inappropriately. This can lead to urinary hesitancy and retention. The bladder starts to release the urine, but then the urethra closes and/or the bladder stops contracting to push the urine out. Included in this scenario may be contractions within the urethra itself, preventing full release of urine. One danger of retention is that some urine may remain in the bladder, leading to an increased risk of bladder infections.