Needing to push to urinate is a common issue. While some mild effort can be normal, persistent straining often signals an underlying problem. Urination involves a complex coordination of muscles and nerves, and disruption can lead to difficulties.
How the Bladder Normally Empties
The process of urination involves the bladder, pelvic floor, and nervous system. The bladder, primarily composed of the detrusor muscle, stores urine. As urine fills, the detrusor remains relaxed, allowing expansion without pressure increases. The bladder neck and urethral sphincters stay closed to prevent leakage. When ready, the brain signals the detrusor to contract forcefully, while the bladder neck and pelvic floor muscles relax, allowing urine to flow out.
Common Reasons for Needing to Push
Many factors can interfere with the bladder’s ability to empty efficiently, leading to the need to push. One common reason is a weakened detrusor muscle, which can occur with age or certain health conditions. When this muscle is less effective, it struggles to generate enough pressure to expel urine.
Obstructions in the urinary tract are another cause of straining. In men, benign prostatic hyperplasia (BPH), an enlarged prostate gland, commonly compresses the urethra, impeding urine flow. In women, pelvic organ prolapse, such as a cystocele where the bladder sags into the vagina, can create a physical blockage. Scar tissue or inflammation can also lead to urethral stricture, a narrowing of the urethra that restricts urine passage.
Damage to the nerves that control bladder function can also disrupt emptying. Conditions like diabetes, stroke, spinal cord injury, and multiple sclerosis can impair communication between the brain and bladder, leading to difficulty initiating or completing urination.
Sometimes, the pelvic floor muscles, which should relax during urination, paradoxically tighten. This condition, known as overactive pelvic floor muscles or dyssynergia, prevents smooth urine outflow, necessitating straining. Individuals may also develop a habitual pattern of pushing, even without a clear physical cause.
Certain medications can also affect bladder function. Drugs with anticholinergic properties, opioids, and some alpha-adrenoceptor agonists can interfere with detrusor muscle contraction or sphincter relaxation, making urination difficult.
What Happens When You Consistently Push
Routinely straining to urinate can have negative physical consequences. The persistent increase in abdominal pressure stresses pelvic floor muscles, potentially leading to weakening or damage, which can compromise bladder support and function. Repetitive pressure also increases the risk of hemorrhoids.
Chronic straining can lead to bladder diverticula, small pouches that trap urine, increasing the risk of urinary tract infections (UTIs). In severe cases, back pressure can affect the kidneys, potentially leading to hydronephrosis or kidney damage. Consistent pushing can also worsen existing conditions like prostate enlargement or pelvic organ prolapse.
When to Consult a Doctor
Consult a healthcare professional if you consistently need to push to urinate. Other symptoms warranting medical evaluation include pain or discomfort during urination, frequent urinary tract infections, or blood in your urine. Difficulty starting or stopping your urine stream, or a feeling of incomplete bladder emptying, should also prompt a doctor’s visit. Any new or worsening urinary symptoms, especially with fever or back pain, require prompt medical attention to identify and address the underlying cause.