Difficulty Starting Urination

difficulty starting urination - urinary hesitation

The purpose of my website is to use my experience to support those suffering from a shy bladder (Paruresis). In this feature I want to look at the topic of difficulty starting urination in both men and women which is often a key symptom of this condition. However, this symptom alone may not be down to Paruresis, there may be other causes too – some of which are quite common. So it’s important you read on.

As we both know, shy bladder syndrome is an inability to urinate when in the real or imaginary presence of others. It’s an anxiety disorder … a social phobia if you like.

The condition affects all sufferers in different ways. To some it’s difficult to pee in any public restroom and anywhere where there’s even a remote chance of being disturbed by someone else. To others it only affects them intermittently and usually only in the really busy and confined restrooms offering little in the way of privacy.

Also, however, there’s another difference to be aware of. For some the difficulty is just in starting urination. Once they’ve “started a flow” they can easily continue regardless of what happens or if anyone disturbs them. To others they just can’t get started full stop. And, if they do, things can  very quickly dry up on hearing footsteps approaching!

So, difficulty starting urinating is a key symptom of paruresis shy bladder. However – difficulty starting urination for both men and women may indicate other conditions too. It can be caused by a number of medical conditions affecting the bladder, kidneys or prostate. Even some medications can cause this side effect too.

My Story

Before we go on I need to advise you again that I am NOT a medical professional. So, if you are having difficulty starting urination you need to seek medical advice. Nothing is better than a face to face consultation with your doctor. More on that later.

What I am is someone who is experienced in this condition who wants to help others. I got through my shy bladder by going the self-help route. There were two specific treatment programs that helped me. Im not saying that they’re guaranteed to work for you too but take a look:

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What Causes Difficulty Starting Urination – Male And Female?

A difficulty starting urination is also known as urinary hesitancy. There are several different causes which can affect both male and female:

Paruresis, Shy Bladder Syndrome

Im going to start off with this one because that’s what my site is all about! This psychological condition, officially categorised as a form of social anxiety, affects both men and women but is more common in men. There’s nothing physically wrong in this case … it’s all in the mind!

Whilst it’s a very common condition that’s seldom openly discussed it’s actually a rarer reason for difficulty starting urination.

Bladder Muscle Damage Or Disorders

We have muscles all over the body – many of which we don’t even know about. For example, have you ever heard of the detrusoe muscles? These are the ones that control the urine in the bladder. Relax and they allow the bladder to fill. Contract and they let the urine out. Should there be anything that effects their functionality then urinary hesitancy can result.

Nerve Damage

Like muscle disorders, anything that affects the nerves around the bladder (either a disorder or damage) can have an effect on urinary release and flow. There are many different issues which could have a detrimental effect on these nerves such as child birth, accident, infections or conditions like MS or a stroke.


Surgery can effect in two ways:

  1. Anaesthetic can impair the localised nervous system
  2. Surgery around the area of the bladder or kidneys can result in scar tissue which can, in turn, effect muscle function.


Various urinary tract infections or UTIs can lead to urinary hesitancy in both men and women. Likewise sexually transmitted infections or STIs can also result in this side effect.

Bladder Obstruction

Any form of growth or tumor which obstructs the bladder or urethra can result in difficulty starting urination.


A number of medications can have a side effect of urinary hesitancy or general problems relating to urination. Certain colds medication, anti-allergy drugs, medication for stomach cramps, muscle spasms etc. Even some anti-depressants can be a cause for both men and women!

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Difficulty Starting Urinating – Men Only!

There’s a common cause that’s specific to men:


The prostate is a gland that is exclusive to men. It’s located in an area surrounding the tube responsible for the outward flow of urine (the urethra).

The prostate gland often enlarges as we age. This doesn’t necessarily mean prostate cancer – it’s commonplace for benign growth of the gland. As it surrounds the urethra it’s logical that any expansion is going to put increased pressure on it and that’s going to cause difficulty starting urination and maintaining a flow.

Obviously, this condition is exclusive to the male sex but is one of the most common reasons for urinary hesitancy.

Difficulty Starting Urinating – Just Women!

Urinary hesitation is actually less common in women than men. For women who have just given birth though this is a fairly common, temporary problem that stems from damage to the nerves around the bladder and urethra as a direct result of childbirth.

Apart from that, and any type of STI or UTI that maybe exclusive to women there’s nothing else that can only affect the female of the species in relation to urinary hesitancy.


Yes … shy bladder syndrome can, and often does, cause a difficulty starting urination but it’s more likely something else. That’s why you need to seek professional medical advice on this to establish exactly what the cause is.

It’s especially important to prioritise this medical consultation if you have other symptoms too. Symptoms such as vomiting or nausea, high temperature or pain in the lower back area. Make that call without delay in these cases. Medical options need to be considered.

One final word on this and we don’t wish to cause alarm but if the condition has deteriorated and you can’t urinate at all this is called urinary retention. And, if this is the case, you need to seek emergency help right away. This could become very serious if not treated early enough so really, don’t delay!

If the diagnosis turns out to be the psychological disorder that we know as shy bladder syndrome then treatment is going to be very different. The challenge will be to repair a fault in the mind rather than a physical problem. But don’t worry … you CAN beat paruresis. Check out our shy bladder treatment reviews.

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- THE most advanced Paruresis self-help program
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- Read Our Review >>