Urinary hesitancy is a symptom of pelvic floor dysfunction where an individual struggles to start urination. When urinating, there are a couple of indicators of normalcy. This includes how long it takes to get started, as well as the ability to maintain the stream.

When you urinate, the stream typically takes a slow-steady-slow pattern: starting off slow, then becoming stronger as you empty the bladder, and lastly slowing again as the bladder empties completely.

Typically, you should be finished emptying your bladder in less than 60 seconds. However, this normal process can be disrupted by a variety of factors.

Taking much longer in the restroom, whether it be starting the stream or emptying the bladder completely, can indicate problems with the pelvic floor muscles. The pelvic floor is the group of muscles responsible for bladder control—holding in urine, starting a stream, and allowing for complete emptying of the bladder.

When these muscles are not in optimal form, it can create urinary hesitancy and other bladder related symptoms.

Other factors can also affect urinary hesitancy—medications, obstructions to the urethra such as prolapse or an enlarged prostate, distractions such as cell phones, and restroom anxiety. These factors can create urinary hesitancy and disrupt your ability to start or maintain a stream of urine.

However, pelvic floor dysfunction is often present even alongside these other causes. Therefore, in the next section, we’ll take a closer look at how pelvic floor dysfunction can create urinary hesitancy.

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Urinary hesitancy created by pelvic floor dysfunction can present itself in a few forms. With pelvic floor dysfunction, your pelvic floor muscles may be tight, weak, or uncoordinated.

When they are tight, your bladder may not relax properly during urination, making it difficult to begin urination, maintain a stream, or empty the bladder completely.

Pelvic floor dysfunction can occur for a wide variety of reasons that differ from person to person—such as your bathroom habits, urination schedule, age, experience with pregnancy, prolapse, surgery and much, much more.

It is best to have your pelvic floor dysfunction diagnosed by a pelvic floor professional in order to better understand your body’s unique needs.

Additionally, stress and anxiety can contribute to tension and tightness of the pelvic floor, which in turn can create difficulties when trying to use the restroom.

This is especially so for folks in the trans community or those who have general restroom anxiety, as relaxing in public restroom environments may prove more challenging for these individuals.

In other scenarios, those who have had surgery and therefore have scar adhesions may also find urination more difficult. This is because scar adhesions can make it difficult for the pelvic floor muscles to relax, resulting in hesitancy when trying to urinate.

This is common for many types of surgeries, such as the following:

• Prolapse surgeries
• Bladder sling surgery 
• Vaginoplasty
• Phalloplasty
• Episiotomy repair
• Prostate surgeries
• C-sections

If your bladder and pelvic floor muscles are not in coordination with each other, they will not contract and relax as needed, making it difficult to initiate urination.

Working with a pelvic floor therapist can help you better understand what’s causing your urinary hesitancy, and in what ways you can work together to address your pelvic floor health and improve your restroom habits.

You may be thinking, “Do I really need to see a physical therapist for urinary hesitancy?”

While urinary hesitancy may not seem like anything more than a small inconvenience, it can actually be accompanied by other symptoms—most of which are also a result of pelvic floor dysfunction.

Incontinence, urgency, frequency, pain, UTIs, and many other conditions are all common symptoms of pelvic floor dysfunction. Even if you don’t currently have these symptoms, pelvic floor dysfunction can worsen if left untreated, so it is unwise to ignore any symptoms you currently have.

Bladder symptoms aren’t just an inconvenience—they can really affect your quality of life and comfort if you allow them to worsen. Rather than spending more time struggling in the restroom, it’s best to do your health a favor and meet with someone who understands your situation.

A pelvic floor therapist is extremely experienced with all things related to the bladder, and therefore can help solve your urinary troubles!

In fact, there are many different treatment methods a pelvic floor physical therapist may use to address your urinary hesitancy. Let’s look at some examples:

Biofeedback and pelvic muscle training: Exercises to help you better understand, feel, and coordinate your pelvic floor muscles.

Manual Therapy: Manual techniques can help release tightness in the pelvic floor muscles, allowing them to relax and perform effectively. Manual therapy can be administered in many ways, such as internally (with your consent first) or externally via many areas of the body: through the abdomen or hips to mobilize the bladder, or through the spine where the nerves that activate the bladder live.

Behavioral modifications and bladder training: This can include voiding schedules, dietary changes, or fluid changes to help regulate urination frequency and reduce hesitancy. You may also learn proper toilet posture and other bathroom habits that can help support healthy urination.

Nerve mobilization: In the case that nerve entrapment may be impacting your ability to urinate properly, your physical therapist will use mobilization techniques to reduce entrapment and irritation of the nerve.

Relaxation techniques: As mentioned before, stress can be a cause of tension in the pelvic floor, which in turn can contribute to urinary hesitancy. Therefore, you may be taught relaxation techniques such as deep breathing to reduce stress and encourage relaxation of the pelvic floor muscles.

Education: As a part of Hive’s comprehensive approach to care, your physical therapy treatment will include plenty of education. That includes education on anatomy or pelvic floor related topics, habits that can harm your ability to urinate effectively, suggestions for maintaining a healthy bladder and voiding schedule, and other tips that may prove useful in the restroom.

As you can see, the pelvic floor therapists at Hive Therapy Wellness use a variety of treatments to address urinary hesitancy and pelvic floor dysfunction.

However, each and every patient’s physical therapy experience is individually curated for their unique needs. Therefore, you may experience any of the following treatments during your treatment plan:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Cupping 
• Behavioral modifications 
• Therapeutic activities 
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback