Feeling like you need to pee but being unable to can be very frustrating and concerning. There are several potential causes for this sensation, ranging from benign to more serious. In the opening paragraphs, we will provide a quick overview of some of the most common reasons you may feel like you have to pee but nothing comes out when you try.
One possibility is that you have a urinary tract infection (UTI). UTIs are more common in women but can occur in anyone. They happen when bacteria get into the urethra and multiply, causing inflammation and discomfort. Along with the constant urge to urinate, other UTI symptoms include burning with peeing, foul-smelling urine, and pelvic pain. UTIs are easily treatable with antibiotics prescribed by a doctor.
Interstitial cystitis (IC) is another condition that can make you feel like you need to pee frequently and urgently. Unlike a UTI, there is no infection with IC. However, it does cause bladder inflammation that leads to pelvic pain and frequent, urgent urination. IC may flare up and improve over time. Lifestyle changes and medications can help manage IC symptoms.
Anatomical Causes
There are some anatomical reasons why you may feel the need to urinate but have trouble voiding your bladder when you try. Let’s explore those causes in more detail.
Prostate Enlargement
One of the most common causes of urinary symptoms in men over 50 is enlargement of the prostate gland. This walnut-sized gland surrounds the urethra right below the bladder. As the prostate grows larger with age, it can constrict the urethra and obstruct urine flow. Signs of an enlarged prostate include:
- Weak urine stream
- Straining or pushing to urinate
- Dribbling after urination ends
- Frequent need to urinate, especially at night
- Feeling unable to fully empty the bladder
Medications like alpha blockers or 5-alpha reductase inhibitors may help shrink the prostate and improve urine flow. In severe cases, procedures like transurethral resection of the prostate (TURP) or laser surgery are options.
Urethral Strictures
Urethral strictures are scar tissue or narrowing in the urethra that restricts urine flow. They can occur after injury, infection, or prostate surgery. Symptoms are similar to an enlarged prostate and may include:
- Weak stream
- Straining to urinate
- Dribbling
- Feeling unable to empty the bladder
Based on the location and extent of the stricture, treatment options include urethral dilatation, urethrotomy, or urethroplasty surgery to widen the narrowed area.
Bladder Stones
Hard mineral deposits (stones) that form in the bladder can block the outflow of urine. This causes symptoms like:
- Painful urination
- Sudden, urgent need to urinate
- Blood in the urine
- Frequent urination, sometimes in small amounts
- Inability to fully empty the bladder
Bladder stones may be removed surgically or broken up with laser lithotripsy. Consuming plenty of fluids may help prevent recurrent stones.
Bladder Prolapse in Women
When the bladder drops down into the vagina due to weakened pelvic floor muscles, it is called a bladder prolapse. Symptoms include:
- Feeling of bladder pressure
- Frequent urge to urinate
- Trouble emptying bladder fully
- Painful urination
- Recurrent UTIs
Kegel exercises to strengthen pelvic floor muscles may help improve mild prolapse. More severe cases may require use of a pessary device or surgery to reposition the bladder.
Nervous System Causes
Problems with the nerves that control the bladder and urination process can also lead to difficulty voiding. Let’s go over some of these causes.
Overactive Bladder
Overactive bladder refers to sudden involuntary bladder muscle contractions that create a strong urge to urinate. It may occur with neurological disorders or for unknown reasons. Symptoms include:
- Frequent and urgent need to urinate
- Waking up multiple times at night to pee
- Incontinence or accidental leakage of urine
Reducing caffeine, following a bladder retraining program, doing pelvic floor exercises, or taking medications to relax the bladder may help calm an overactive bladder.
Multiple Sclerosis
Between 50-80% of people with multiple sclerosis (MS) experience bladder dysfunction. MS damages the nerves that send signals between the brain and bladder. This can lead to symptoms like:
- Hesitancy starting urine flow
- Weak stream
- Dribbling
- Feeling unable to fully empty the bladder
- Urgency and frequency
- Incontinence
Medications, catheterization, pelvic floor therapy, and other strategies can improve bladder control and urination for MS patients.
Parkinson’s Disease
Parkinson’s disease can make bladder muscles stiff and contracted. This prevents them from fully relaxing to store urine normally. Symptoms include:
- Hesitancy starting to urinate
- Dribbling urine
- Frequent small bladder voiding
- Urgency and frequency, especially at night
Parkinson’s medications may help regulate bladder function. Timed voiding schedules, limiting fluids before bedtime, and pelvic exercises can also minimize symptoms.
Spinal Cord Injury
When nerves connecting the spinal cord to the bladder are damaged, normal bladder function is disrupted. This can lead to:
- Inability to sense a full bladder
- Trouble initiating urine flow
- Weak stream and incomplete bladder emptying
- Incontinence
Catheterization, medications, and sometimes surgical procedures can help manage neurogenic bladder caused by spinal cord injuries.
Other Potential Causes
Here are a few other possibilities that may make you feel like you need to pee frequently but have difficulty voiding:
- Urinary retention – Partial or complete inability to empty the bladder. Can result from nerve problems, blockage, constipation, or side effects of medication.
- Pregnancy – Hormonal changes and increased bladder pressure from the weight of the uterus can cause frequent urination and urgency.
- Diabetes – Nerve damage and bladder muscle issues from high blood sugar levels may impair normal urination.
- Negative fluid balance – Dehydration from inadequate fluid intake, frequent diarrhea, vomiting, or excessive sweating can make urine very concentrated and difficult to void.
- Anxiety – Feeling anxious activates the fight-or-flight response which can make you feel the urge to urinate. But when you try, little comes out due to tense pelvic floor muscles.
- Constipation – Hard, infrequent stools can put pressure on the bladder causing the feeling of incomplete voiding.
Diagnosis
To determine the cause of urinary symptoms, the doctor will begin with a thorough medical history. Be prepared to describe your symptoms in detail including:
- When symptoms began and how frequent they are
- Associated pain or discomfort
- Any other bladder or urinary changes
- Amount of daily fluid intake
- Medications you take
- Childbirth history for women
The physical exam will check for signs of infection, anatomical abnormalities, enlarged prostate, pelvic prolapse, and neurological function. The doctor may gently feel the abdomen to assess the bladder size and any masses or tenderness.
Urinalysis
Examining a sample of your urine under a microscope can check for signs of infection, blood, crystals, and other abnormalities. This simple test provides clues about potential causes.
Post-Void Residual Volume
This test uses ultrasound to measure how much urine remains in the bladder after voiding. A significant amount of leftover urine suggests an obstruction or impaired bladder emptying.
Cystoscopy
A small camera is inserted through the urethra into the bladder allowing the doctor to visually inspect the bladder lining for any lesions, stones, or anatomical problems.
Urodynamics
This suite of tests evaluates bladder function and urinary tract conditions. It involves filling the bladder with fluid and measuring pressure and muscle contractions involved in urination.
Imaging Tests
Imaging like an abdominal ultrasound, CT scan, MRI, or intravenous pyelogram (IVP) allows visualization of the bladder, kidneys, and urinary tract to check for any abnormalities or blockages.
| Test | What it checks |
|---|---|
| Urinalysis | Infection, blood, crystals, cells |
| Post-void residual urine volume | Incomplete bladder emptying |
| Cystoscopy | Inside of bladder lining and urethra |
| Urodynamics | Bladder pressure and function |
| Imaging tests | Structural abnormalities |
Treatments
Treatment will depend on the underlying cause of your urinary symptoms. Here are some general treatment approaches:
Medications
Types of medications that may improve bladder function and urination include:
- Antibiotics for UTIs
- Alpha blockers or 5-alpha reductase inhibitors for enlarged prostate
- Antimuscarinics or beta-3 agonists for overactive bladder
- Muscle relaxants
Pelvic Floor Therapy
Pelvic floor exercises with a physical therapist can help strengthen and relax muscles involved in urination. Biofeedback training is sometimes used.
Catheterization
Intermittent self-catheterization to fully empty the bladder may be recommended for some forms of urinary retention.
Surgery
Different types of surgery can resolve anatomical obstructions or bladder prolapse contributing to symptoms:
- Transurethral resection of prostate (TURP)
- Urethroplasty
- Cystolitholapaxy to remove bladder stones
- Sling procedures to reposition prolapsed bladder
Minimally invasive procedures have quicker recovery times. Discuss risks vs. benefits of surgery with your urologist.
Lifestyle Changes
Modifying certain habits may improve bladder control and urinary flow:
- Timed or scheduled voiding
- Double voiding to empty bladder more fully
- Limiting caffeine and acidic foods
- Doing regular Kegel exercises
- Stopping smoking
- Maintaining healthy weight
Tracking your symptoms in a bladder diary can help identify triggers and patterns.
When to See a Doctor
You should make an appointment with your doctor if you consistently experience:
- Frequent and urgent need to urinate but difficulty voiding
- Pain or burning with urination
- Blood in the urine
- Weak urine stream
- Incontinence
- Waking up multiple times at night to urinate
Seeking timely treatment is important to identify any serious condition requiring specific treatment and to improve quality of life.
Conclusion
Feeling like you constantly need to pee but being unable to pass more than a small amount of urine or none at all can signal various underlying problems. From UTIs to enlarged prostate to overactive bladder, the irritating and concerning symptom of ineffective urination has numerous potential causes. Diagnostic tests like urinalysis, post-void residual volume, cystoscopy, urodynamics, and imaging can pinpoint the reason. Treatment options range from antibiotics and medications to pelvic floor therapy, catheterization, and surgery. Lifestyle adjustments may also improve bladder control and urination. Prompt medical attention for persistent symptoms can identify any serious bladder conditions and lead to appropriate treatment to resolve the issue and provide relief.