Urgency, Frequency & Hesitancy in Urination

Why do I pee all the time? Why does almost nothing come out when I go?

Urgency, frequency and hesitancy – these are some of the biggest issues that may be separate from or in addition to leakage. Although they may seem to be contradictory, 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 muscle walls may become less compliant. That compliance, or flexibility within the bladder walls, helps define when the body senses urgency. Basically, the bladder is 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 not enough), then the ability of the bladder to register that “critical point” is changed. 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: Just as the bladder can contract when it shouldn’t, it can also relax inappropriately. Then the bladder will fill past that critical point, leading to urinary hesitancy and retention. With hesitancy, 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, at the bladder neck or ineffective bladder contractions – all preventing full release of urine. One danger of retention is that some urine may remain in the bladder which can cause an increased risk of bladder infections.

The good news? Notice that nerves and muscles are involved in much of this process. Even though most of these are smooth muscles (ie, not under voluntary control), they can still be retrained! That’s where physical therapy can help. A trained pelvic PT will consider how everything in the trunk, hips and pelvis may be contributing to this altered bladder-urethra-pelvic floor pattern and give you the tools to regain control over voiding again.