HESITANCY OR DIFFICULTY STARTING URINE STREAM
Hesitancy in starting your urine stream can be a sign of pelvic floor dysfunction. This can either be because the pelvic floor muscles are not relaxing during urination and/or due to urinary frequency or prolapse (See Over Active Bladder and Pelvic Prolapse for more information).
The pelvic floor and bladder have a reciprocal relationship. This means when you sit down to urinate the bladder (detrusor muscle) contracts to void out the urine and the pelvic floor muscles should be relaxed to allow this to happen. When the reciprocal relationship is no longer coordinated due to pelvic floor muscle tone or spasm (or bad habits), the pelvic floor muscles will inhibit the bladder contraction by not fully relaxing causing difficulty or hesitancy with starting the urine stream (as well as Incomplete Bladder Emptying). This is an important reason why you should never Kegel during urination (stopping urine flow by contracting pelvic floor muscles) as it contributes to incoordination of the bladder and pelvic floor muscles.
However, often times increased urinary frequency will lead to hesitancy in starting the urine stream because the bladder is not full and ready to empty yet despite the urge or feeling–remember the signals are mixed up so the urge is misleading. When you urinate before your bladder has time to fill up you ultimately mix up the signals to the brain on when the appropriate time to urinate is resulting in voiding dysfunctions including urinary frequency, urge, hesitancy with starting urine stream and feeling of incomplete bladder emptying. The bladder may actually be empty but the signals are crossed so you do not feel that satisfaction and you may experience a constant urge to urinate. Bladder Retraining is the most effective treatment for improving this regardless of etiology to restore normal function and signals. If hesitancy is also accompanied by pelvic pain then manual therapy from a pelvic floor physical therapist is also indicated to decreased hypertonicity of pelvic floor muscles.