Why Does It Feel Like I Have to Pee but Nothing Comes Out?

Feeling the constant urge to urinate but struggling to pass little or no urine can be frustrating, uncomfortable, and even alarming. This sensation can interfere with daily life, disrupt sleep, and cause anxiety. If this sounds familiar, it’s important to understand why it happens and what you can do to achieve lasting relief.

One of the most common causes in men is benign prostatic hyperplasia (BPH), also known as an enlarged prostate. BPH affects nearly half of men over 50 and up to 90% of men over 80. While not cancerous, it can significantly affect urinary flow because of the prostate’s position around the urethra, the tube that carries urine out of the body.

What Happens When You Have an Enlarged Prostate?

As men age, the prostate gland can enlarge and compress the urethra, restricting urine flow and preventing the bladder from fully emptying. This obstruction can cause a group of issues known as lower urinary tract symptoms, including a weak urine stream, difficulty starting urination, and urinary retention.

When the bladder has to push harder against this blockage, it can become thickened, overworked, and less flexible over time. Eventually, this leads to bladder dysfunction and the frequent sensation of needing to urinate but not being able to.

Recognizing the Symptoms of Urinary Retention

The feeling of needing to urinate but passing little or no urine is often caused by urinary retention, a common complication of BPH. It may develop slowly or appear suddenly, and the symptoms can range from mildly inconvenient to medically urgent.

Common Urinary Retention Symptoms in Men

• Difficulty starting urination (urinary hesitancy)
• Weak or interrupted urine stream
• Dribbling after urination
• Frequent urination, especially at night (nocturia)
• Sudden, strong urge to urinate (urgency)
• Sensation of incomplete bladder emptying
• In severe cases: complete inability to urinate (a medical emergency)

If you experience any of these symptoms, especially an inability to urinate, you should seek immediate medical attention.

Why Does Urinary Hesitancy Happen?

Urinary hesitancy, difficulty starting or maintaining urination, is often a direct result of the prostate pressing on the urethra. When the prostate enlarges, it presses on the bladder, falsely creating a sensation of needing to urinate. The bladder must generate extra pressure to overcome this blockage, which can cause urination to be slow, hesitant, or stop-and-start. Ignoring this symptom can allow bladder strain to worsen, leading to chronic urinary retention, bladder infections, or even kidney damage.

The Risks of Untreated Urinary Retention

Chronic retention can silently cause complications over time, including:

• Bladder infections
• Bladder stones
• Kidney swelling (hydronephrosis)
• Kidney damage from backed-up urine

Severe, acute retention is painful and requires immediate treatment to relieve the bladder. Addressing the underlying cause early, such as an enlarged prostate, is important to preventing these complications.

Treating the Underlying Cause: Enlarged Prostate (BPH)

When BPH causes urinary retention, hesitancy, or weak urine flow, treatment focuses on reducing prostate size and relieving pressure on the urethra. Approaches range from simple lifestyle adjustments to minimally invasive procedures.

Common Treatment Options for BPH

1. Medications to Improve Urine Flow

Alpha-blockers relax the muscles of the prostate and bladder, while 5-alpha reductase inhibitors gradually shrink the prostate, helping to improve urinary symptoms over time.

2. Lifestyle Adjustments to Reduce Symptoms

Simple changes, such as limiting caffeine and alcohol or reducing fluid intake before bedtime, can help manage urinary urgency, nighttime trips, and bladder discomfort.

3. Minimally Invasive Procedures: Prostate Artery Embolization (PAE)Prostate artery embolization (PAE) is a cutting-edge, image-guided procedure that reduces blood flow to the prostate, causing it to shrink naturally. This outpatient procedure improves urine flow, decreases retention, and alleviates BPH symptoms without surgery.

Why Choose Prostate Artery Embolization for BPH?

PAE is a minimally invasive, image-guided procedure that directly targets the cause of urinary retention: an enlarged prostate. During PAE, an interventional radiologist inserts a small catheter into an artery in your wrist or groin and navigates it to the arteries supplying the prostate. Tiny particles are then injected to block blood flow, causing the prostate to shrink naturally over time. As the prostate decreases in size, urine flow improves, and symptoms like hesitancy, weak stream, and the constant urge to urinate significantly decrease.

Benefits of PAE

• No hospital stay; it’s performed as an outpatient procedure
• Quick recovery and minimal discomfort
• Very low risk of sexual side effects or incontinence
• Effective symptom relief for 85–90% of patients
• Proven, long-lasting improvement in urinary function

Unlike traditional surgery, PAE allows most men to return to normal activities within a few days, with a noticeable improvement in urinary symptoms within weeks.

Expert BPH Treatment in New York City

American Prostate Centers’ affiliated board-certified interventional radiologists in Long Island City specialize in prostate artery embolization for men suffering from urinary retention and related symptoms of BPH. Prostate artery embolization offers a fantastic alternative for men who haven’t found relief through medications or who are looking for options beyond traditional surgery. Schedule an appointment today for enlarged prostate relief in Queens.