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Hesitating, Straining, and Dribbling

by Anuja P. Shah, MD

A hesitating start when urinating, a need to strain, a weak and trickling stream of urine, and dribbling at the end of urination are common symptoms of a partially obstructed urethra. In men, these symptoms are caused most commonly by an enlarged prostate that compresses the urethra and less often by a narrowing (stricture) of the urethra. Similar symptoms in a boy may mean that he was born with an abnormally narrow urethra or has a urethra with an abnormally narrow external opening. The opening may also be abnormally narrow in women.

A doctor examines the prostate by inserting a gloved, lubricated finger into the man’s rectum (digital rectal examination). If the prostate is enlarged, a blood test to measure the level of prostate specific antigen (PSA) is done. Sometimes ultrasonography of the prostate is also done. If a urethral stricture is suspected, the doctor may insert a flexible viewing tube into the bladder (cystoscopy).

To treat an enlarged prostate, doctors can use drugs or surgery. To treat a urethral stricture in a man, doctors may insert a catheter into the bladder through the penis and dilate (stretch) the urethra. It may be necessary to insert a hollow tube to hold the urethra open (a stent). Surgeons may rebuild the urethra or use other surgical treatments.