Written and clinically reviewed by Mr Daniel Swallow, Consultant Urologist (GMC 6128674). Last reviewed: .
Is a weak urine stream normal?
The stream often weakens gradually with age, and many men adjust without noticing. It is not something you have to put up with, though. A slow stream, hesitancy before it starts, stopping and starting, straining, and dribbling at the end are all signs that the bladder is working against some resistance.
What causes it?
- Benign prostate enlargement. By far the most common cause in men over 50, as the gland squeezes the urethra (see enlarged prostate).
- A urethral stricture: scarring that narrows the water pipe. It can occur at any age, often after a catheter, injury or infection.
- A weak bladder muscle, sometimes related to diabetes or nerve problems.
- Medicines, including some cold and allergy remedies containing decongestants, certain bladder tablets and strong painkillers.
- Constipation can also press on the bladder outlet and is easily overlooked.
Make an appointment if the stream has changed noticeably, you feel you are not emptying, or you have repeated urine infections. Blood in your urine, or pain when passing urine, should be seen urgently: ask for an urgent GP appointment or call NHS 111. Delaying matters because a bladder that stays overfull can, over time, affect the kidneys.
If you are suddenly unable to pass urine at all, or have a painful, swollen lower tummy, you need urgent help the same day (this is called acute urinary retention). Call NHS 111 or go to A&E rather than waiting for an appointment.
How it is assessed
- A symptom questionnaire (the IPSS score) and a review of your medicines
- An examination, including of the prostate where appropriate, and a urine test
- A flow test (you simply pass urine into a measuring device) and a quick ultrasound scan to check that your bladder empties
- Blood tests, including kidney function and, after a discussion of the pros and cons, a PSA
Treatment options
These depend on the cause and how much it bothers you. They include simple lifestyle changes, tablets to relax the prostate or shrink it, and for men who need more, surgery. HoLEP (holmium laser enucleation of the prostate) is an effective option for prostates of any size, and Aquablation, a robotic waterjet operation, is another. Mr Swallow is trained in both. A stricture needs a different treatment, which is why a proper diagnosis comes first.
Common questions
Does a weak stream mean I have prostate cancer?
Usually not. Benign enlargement is far more common. Early prostate cancer often causes no urinary symptoms at all, which is why a PSA test is discussed as part of assessment for men who are concerned.
Will it get worse if I leave it?
It may, though not in everyone. Getting it assessed lets you decide with full information, and picks up the minority of cases where waiting could affect the bladder or kidneys.
Do I have to have surgery?
No. Many men are well controlled with lifestyle changes or medication. Surgery is considered when symptoms are bothersome and other treatments have not helped, or when complications develop.
Discuss this with Mr Swallow in London or Chelmsford
A flow test and assessment can give a clear answer. You can book online, or call the private secretary.
Further reading from trusted sources
Information on this page follows patient guidance published by the British Association of Urological Surgeons (BAUS). External links open on the NHS and NICE websites, which are not run by Mr Swallow.