Weak stream, straining or incomplete emptyingKamzor dhaar, zor lagana ya peshab ka poora khali na hona

Yeh alamaat kya hain

Aap dekh sakte hain ke peshab dheere shuru hota hai, kamzor dhaar se aata hai ya ruk ruk kar aata hai, bohat der lagti hai, ya zor lagana parta hai. Aakhir mein boondein tapak sakti hain, aur aap ko mehsoos ho sakta hai ke bladder poora khali nahi hua, is liye jaldi dobara jana parta hai. Doctor in aur peshab ke doosre masail ko lower urinary tract symptoms, yaani LUTS, kehte hain.

Kamzor dhaar aur peshab ka poora khali na hona khali karne ki alamaat kehlati hain. Yeh jama karne ki alamaat se mukhtalif hain, maslan baar baar peshab aana, achanak shiddat se peshab ki hajat, aur raat ko peshab ke liye uthna. Bohat se logon mein dono qisam ki alamaat hoti hain.

Yeh tabdeeliyan aksar aahista aahista aati hain, is liye bohat se log bina notice kiye in ke aadi ho jate hain. Yeh aam hain, khaas tor par umar rasida mardon mein, lekin yeh bardasht karne ki cheez nahi. Wajah maloom ki ja sakti hai aur aksar is ka ilaaj ho sakta hai.

Meherbani karke is ke liye chemist ke counter ya hakeem se goliyan ya jari bootiyan na lein. Yeh wajah nahi dhoondtin, aur us masle ko chhupa sakti hain jise sahi ilaaj ki zaroorat hai.

Aam wajohat

Dhaar ka sust ya adhoora bahao tab hota hai jab koi cheez nikasi ko tang ya band kar de, ya jab bladder ka muscle ya us ki nasein theek kaam na karein. Aksar yeh dono ka milaap hota hai. Aam wajohat yeh hain:

• Barha hua prostate mardon mein, aam tor par darmiyani umar ke baad. Gland peshab ki nali ko dabata hai. Umar rasida mardon mein yeh sab se aam wajah hai (dekhein enlarged prostate guide).
• Peshab ki nali mein tangi ya nishan (stricture), infection, chot ya catheter ke baad (dekhein urethral stricture guide).
• Kamzor ya sust bladder muscle, lambay arse tak zyada phailne se, umar ki wajah se, ya diabetes se nasein mutasir hone se.
• Nasoon ke masail, maslan reeh ki haddi ke masail (dekhein neurogenic bladder guide).
• Kuch dawaiyan, maslan zukam aur allergy ki kuch goliyan, kuch antidepressants aur overactive bladder ki kuch dawaiyan. Meherbani karke likhi hui dawai khud band na karein: us doctor se poochhein jis ne likhi hai.
• Qabz, kyunke bhari hui aanth bladder ki nikasi ko dabati hai.
• Infection ya sooja peshab ki nali, bladder ya prostate ka (dekhein urine infection guide).
• Bladder ki pathri jo nikasi ko band kar sakti hai (dekhein bladder stones guide).
• Bladder ya bachadani ka neeche dhalak jana (prolapse) auraton mein, jis se khali karna mushkil ho sakta hai.
• Prostate cancer, jo kam aam hai magar wohi alamaat de sakta hai (dekhein prostate cancer guide). Barha hua prostate cancer nahi hota, aur cancer mein tabdeel nahi hota.

Kaun si wajah hai yeh ilaaj tay karti hai, is liye andaaza kaafi nahi. Sahi jaanch aam tor par wajah dhoond leti hai.

Inhein nazar andaaz kyun nahi karna chahiye

Jo bladder poori tarah khali na ho us se waqt ke saath masail ho sakte hain:

• Peshab ke infection jo baar baar aate hain.
• Bladder ki pathri, jo peeche reh jane wale peshab se banti hai.
• Phaila hua, kamzor bladder jo har saal pehle se kam kaam karta hai.
• Kidneys par peshab ka dabao, jo unhein khamoshi se, bina dard ya warning ke nuqsan pohancha sakta hai.
• Peshab tapakna ya leak hona jab bladder zyada bhar jata hai.
• Achanak mukammal rukawat (urinary retention), jo emergency hai (dekhein urinary retention guide).

Yeh tabdeeliyan aahista aahista barhti hain, is liye aisa koi lamha kam hi aata hai jo doctor ko dikhane ka sahi waqt lage. Isi liye jo dhaar mazeed kamzor hoti jaye use jaldi dikhana chahiye, chahe woh aap ko zyada pareshan na kare.

Ilaaj tab sab se behtar kaam karta hai jab bladder ya kidneys ko nuqsan na pohancha ho. Intezar se ilaaj shayad hi aasaan hota hai.

Jaanch aam tor par kaise hoti hai

Aap ke doctor aap ki alamaat ke baare mein poochhenge (aksar chhote sawalnaame ke saath), aap kya peete hain, aap ki dawaiyan, aur pehle ke infection, chotein ya operations. Phir muaina karenge. Mardon mein is mein prostate ka narm muaina bhi hota hai jo pakhane ki nali ke raste se kiya jata hai. Aam tests yeh hain:

• Peshab ka test, infection aur khoon dekhne ke liye.
• Khoon ke tests, yeh dekhne ke liye ke kidneys kitni theek kaam kar rahi hain. Mardon mein PSA khoon ka test bhi diya ja sakta hai, is baat cheet ke baad ke nateeja kya bata sakta hai aur kya nahi.
• Bladder diary: chand din ke liye likhna ke aap kab peete hain, kab peshab karte hain, aur kitna.
• Peshab ke bahao ka test aur bladder scan: aap aise khaas toilet mein peshab karte hain jo dhaar napta hai, phir aik tez ultrasound scan dikhata hai ke bladder mein kitna peshab reh gaya.
• Kidneys aur bladder ka ultrasound: dard ke baghair scan jo kidneys aur bladder dekhta hai aur pathri dikha sakta hai.
• Bladder ke andar camera se dekhna (flexible cystoscopy), agar tangi ya koi aur masla shak ho.
• Pressure tests (urodynamics) kuch logon mein, yeh dekhne ke liye ke bladder ka muscle aur nikasi mil kar kaise kaam karte hain.

Aap ko in sab ki zaroorat nahi hogi. Aap ke urologist wohi tests chunenge jo aap ke liye munasib hon, aur kaun se tests dastiyab hain yeh is par munhasir hai ke aap ka ilaaj kahan ho raha hai.

Ab kya karein

• Urologist ko dikhayein, ya aise doctor ko jo aap ko refer kar sake, chahe alamaat aap ko thori hi pareshan karein.
• Apne kaghazat saath le jayein: pehle ke peshab ke reports, scans, PSA aur khoon ke tests, aur har dawai ki list jo aap lete hain, jis mein zukam aur allergy ki goliyan aur jari booti wali cheezein bhi shamil hain.
• Dikhane se pehle chand din aasaan bladder diary rakhein: peshab karne ke waqt, andaazan kitna, aur aap kya peete hain.
• Peshab se bachne ke liye paani kam na karein. Kam paani peene se infection aur pathri ka imkaan barhta hai. Aam tarah, din bhar mein paani peeyein.
• Hajat hone par jayein, der tak na rokein, aur faarigh hone ke baad zara ruk kar dobara koshish karein taake zyada khali ho.
• Aaraam se waqt lein aur zor se zor na lagayein. Baith kar peshab karna kuch mardon ki madad karta hai.
• Qabz ka ilaaj karein: phal, sabziyan, resha aur kaafi paani.
• Chai, coffee aur fizzy drinks kam karein agar aap ko lage ke in se zyada baar peshab aata hai.
• Tests ke baad poochhein ke nateejon ka kya matlab hai, ilaaj ke kaun se tareeqay hain, aur aap ko kab dobara aana hai.

Aam sawalaat

What these symptoms are

You may notice that urine starts slowly, comes out weakly or in a stop-start way, takes a long time, or needs straining. It may dribble at the end, and you may feel that the bladder has not emptied fully, so you need to go again soon. Doctors group these and other urine problems under the name lower urinary tract symptoms, or LUTS.

A weak stream and incomplete emptying are called emptying symptoms. They are different from storage symptoms such as passing urine very often, a sudden urgent need to go, and getting up at night to pass urine. Many people have both kinds.

These changes usually come on slowly, so many people get used to them without noticing. They are common, especially in older men, but they are not something to accept. The cause can be found and can often be treated.

Please do not buy tablets or herbal products from a chemist counter or a hakeem for this. They do not find the cause, and they can hide a problem that needs proper treatment.

Common causes

A slow or incomplete flow happens when something narrows or blocks the way out, or when the bladder muscle or its nerves are not working well. Often it is a mixture. Common causes are:

• An enlarged prostate in men, usually from middle age onwards. The gland presses on the urine tube. It is the most common cause in older men (see the enlarged prostate guide).
• A narrowing or scar in the urine tube (a stricture), after an infection, an injury or a catheter (see the urethral stricture guide).
• A weak or underactive bladder muscle, from long-term overstretching, from ageing, or from diabetes damaging the nerves.
• Nerve problems, such as spinal cord conditions (see the neurogenic bladder guide).
• Some medicines, such as some cold and allergy tablets, some antidepressants and some medicines for overactive bladder. Please do not stop a prescribed medicine on your own: ask the doctor who prescribed it.
• Constipation, because a full bowel presses on the bladder outlet.
• Infection or inflammation of the urine tube, bladder or prostate (see the urine infection guide).
• Bladder stones, which can block the outlet (see the bladder stones guide).
• A dropped bladder or womb (prolapse) in women, which can make emptying difficult.
• Prostate cancer, which is less common but can cause the same symptoms (see the prostate cancer guide). An enlarged prostate is not cancer, and it does not turn into cancer.

Which cause it is decides the treatment, so guessing is not enough. A proper check usually finds it.

Why it should not be ignored

A bladder that does not empty fully can cause problems over time:

• Urine infections that keep coming back.
• Bladder stones, which form from urine left behind.
• A stretched, weaker bladder that works less well each year.
• Back-pressure on the kidneys, which can damage them quietly, without pain or warning.
• Leaking or dribbling when the bladder becomes overfull.
• Sudden complete blockage (urinary retention), which is an emergency (see the urinary retention guide).

These changes build slowly, so there is rarely a moment that feels like the right time to see a doctor. That is why a stream that keeps getting weaker should be checked early, even if it does not bother you much.

Treatment works best before the bladder or kidneys are damaged. Waiting rarely makes it easier.

How it is usually investigated

Your doctor will ask about your symptoms (often with a short questionnaire), what you drink, your medicines, and any past infections, injuries or operations. Then they will examine you. In men this includes a gentle examination of the prostate through the back passage. Usual tests are:

• Urine test, to look for infection and blood.
• Blood tests, to check how well the kidneys are working. In men, a PSA blood test may be offered after a talk about what the result can and cannot tell you.
• A bladder diary: a record of when you drink and pass urine, and how much, for a few days.
• A urine flow test and bladder scan: you pass urine into a special toilet that measures the stream, then a quick ultrasound scan shows how much urine is left in the bladder.
• Ultrasound of the kidneys and bladder: a painless scan that looks at the kidneys and bladder and can show stones.
• A camera look inside the bladder (flexible cystoscopy), if a narrowing or another problem is suspected.
• Pressure tests (urodynamics) in some people, to see how the bladder muscle and the outlet work together.

You will not need all of these. Your urologist will choose the tests that suit you, and which tests are available depends on where you are treated.

What to do next

• See a urologist, or a doctor who can refer you, even if the symptoms bother you only a little.
• Take your papers: earlier urine reports, scans, PSA and blood tests, and a list of every medicine you take, including cold and allergy tablets and herbal products.
• Keep a simple bladder diary for a few days before the visit: the times you pass urine, roughly how much, and what you drink.
• Do not cut down on water to avoid going. Drinking too little makes infections and stones more likely. Drink normally, spread through the day.
• Go when you feel the need, do not hold on for long, and after you finish wait a moment and try again to empty more.
• Take your time and relax rather than straining hard. Sitting down to pass urine helps some men.
• Treat constipation: fruit, vegetables, fibre and enough water.
• Cut down on chai, coffee and fizzy drinks if you notice they make you go more often.
• After the tests, ask what the results mean, what treatment options you have, and when you should come back.

Common questions