Pelvic Floor Symptom
Straining to Urinate
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
Urination takes effort. You have to push or bear down to keep the stream going, and you often feel you have not finished. It seems like the right thing to do, but straining tightens the muscles that need to relax.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding Straining to Urinate
Normally the bladder does the work of emptying while the pelvic floor relaxes. You should not need to push. Straining to urinate means something is resisting flow, either an obstruction such as prostate enlargement or a stricture, a weak bladder muscle, or a pelvic floor that is not relaxing.
A pelvic floor that does not relax is common and often missed. When people strain, abdominal pressure increases and the pelvic floor instinctively tightens against it, making flow slower still. Over time this creates a cycle of straining, tightening and incomplete emptying, along with pelvic and perineal aching.
A 2026 review in the journal Medicina by Barber and Biancaniello brought this research together. It proposes that trigger points in the pelvic floor send a steady stream of signals into the nervous system that can be felt as urgency, frequency or bladder discomfort, and it recommends checking the pelvic floor in people with these symptoms. Read the review.
Your physician or urologist should check for obstruction and bladder function. Dr. Gordon treats the pelvic floor side and helps you empty without straining.
Straining to Urinate at a Glance
Also called
Urinary straining, difficulty voiding
Who it affects
Men and women
Causes to rule out
Prostate enlargement, urethral stricture, weak bladder muscle, nerve conditions
Common pelvic floor cause
A pelvic floor that tightens instead of relaxing
Why straining backfires
Pushing raises pressure and makes the pelvic floor clamp down further
The Gap in Care
What Tests Check, and What They Can Miss
Straining is usually evaluated as an obstruction problem. When the pelvic floor is the resistance, flow tests may show slow emptying without explaining why.
What routine testing is looking for
- Prostate enlargement
- Urethral stricture
- Weak bladder muscle
- Nerve conditions affecting the bladder
What often keeps symptoms going
- A pelvic floor that tightens when you push
- High resting tone
- Trigger points that resist relaxation
- Breath holding during urination
- A long-standing straining habit
These are assessed with pelvic floor testing, which complements your urologist's evaluation.
Signs & Symptoms
Does This Sound Like You?
Symptoms vary from person to person. These are the patterns Dr. Gordon sees most often.
Pushing to keep the stream going
Needing to bear down throughout urination.
Slow, weak stream
Flow that is slow and takes a long time.
Stop-and-start flow
The stream stopping and restarting.
Incomplete emptying
Feeling like there is urine left.
Pelvic or perineal ache
Aching after urinating from straining.
Dribbling afterward
Leakage after you think you are done.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Finding which one leads makes treatment more efficient.
Pelvic floor resistance
The pelvic floor does not relax, so urine meets resistance.
Reflex tightening with pushing
Straining raises abdominal pressure, and the pelvic floor clamps down in response.
High tone and trigger points
Chronic tension limits how far the muscles can relax.
Habits
Rushing and straining become automatic over time.
Your First Visit
How Dr. Gordon Evaluates Straining to Urinate
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of what is driving your symptoms, a written plan, a realistic timeline, and in most cases your first treatment.
Records and history review
Dr. Gordon reviews your physician's findings, imaging, medications and past treatments so he knows what has been ruled out and what has already been tried.
Breathing and pushing check
Dr. Gordon looks at how your breathing and abdomen work during urination.
External pelvic floor assessment
The pelvic floor muscles are examined from the outside, with no internal exam. With you draped for comfort, gentle pressure around the perineum, sit bones, tailbone and inner thighs checks tone, tenderness and trigger points.
Voiding pattern review
Dr. Gordon reviews how long urination takes, straining habits and positions.
Plan and coordination
A clear plan, plus communication with your physician or pelvic floor PT when that helps your care.
When to see a physician first
- Fever or chills with pelvic or urinary symptoms
- Inability to urinate
- Visible blood in the urine or stool
- Sudden, severe pelvic or abdominal pain
- Unexplained weight loss
- New numbness in the saddle area or loss of bladder or bowel control
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for straining to urinate, chosen from your exam findings.
Primary approach
Intrapelvic & Extrapelvic Dry Needling
Dr. Gordon holds ASE certification in both intrapelvic and extrapelvic dry needling. Treatment releases pelvic floor tension that resists urine flow, so emptying takes less effort. The needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum.
Learn about pelvic floor treatmentNerve focus
Neuro-Functional Acupuncture
Gentle electro-acupuncture to support bladder and pelvic floor coordination.
See servicesBetween visits
Voiding Plan & Team Coordination
Positioning and breathing strategies to empty without straining, coordinated with your urologist.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Visits 1 to 3
Find the main driver
Dr. Gordon confirms which muscles and nerves are behind your symptoms and starts calming the most reactive areas. Many people notice early changes between visits.
Visits 4 to 8
Lower the baseline
Day-to-day symptoms ease, flares become shorter and less frequent, and normal routines start to feel more manageable.
Visits 9 to 12 and beyond
Build resilience
Visits are spaced out as improvement holds. You leave with a maintenance and early-flare plan.
Most patients are seen weekly or every other week during active care. Individual results vary with how long symptoms have been present and how reactive they are. Progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
"I went there because my wife made me to. I'm glad she did it was a very positive experience. Dr Anthony and his nursing staff are top-notch extremely friendly very thorough and actually care about your comfort."
Steve B, Google Review
Straining to Urinate Questions
Answers About Straining to Urinate
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
No. The bladder should do the work. Pushing tightens the pelvic floor and slows flow.
In men, prostate enlargement is possible and should be checked. Pelvic floor tension often adds to it.
Hesitancy is difficulty starting. Straining is needing to push throughout. They often happen together.
Yes. It is common with pelvic floor tension and sometimes prolapse.
Many people improve within six to ten sessions.
For women, sitting fully with feet supported and leaning slightly forward often helps. Dr. Gordon tailors recommendations.
Before You Book
General Questions
The clinic is an out-of-network practice. The initial evaluation is $300 and follow-up visits are $250. After each visit you receive a detailed superbill to submit to your PPO plan for possible reimbursement. FSA and HSA cards are accepted, and the clinic can run a complimentary benefits check before your first appointment. The check is a courtesy, so please confirm your coverage with your plan. See Insurance & Fees for details.
The first evaluation is 60 to 75 minutes and usually includes treatment. Follow-up visits run 45 to 60 minutes.
Yes. Call (516) 597-5400 or send a message through the contact page. This is especially helpful if your case is complex and you want to understand the approach before committing to a full evaluation.
1508 Union Turnpike, Suite 133, North New Hyde Park, NY 11040, with free parking on site. The clinic is an easy drive from Manhasset, Great Neck, Garden City, Lake Success, Floral Park and Mineola. Early morning, evening and weekend hours are available.
Most people feel a quick muscle twitch or a deep ache that lasts a few seconds. That twitch is a normal sign the trigger point is releasing. Mild soreness for 24 to 48 hours afterward, similar to a hard workout, is common. Depth, angle and stimulation are adjusted to your comfort.
Both use the same fine, sterile, single-use needles. Dry needling targets specific trigger points and tight bands in muscle based on your exam. Neuro-functional acupuncture targets nerve pathways, often with gentle electrical stimulation, to calm nerve sensitivity. For straining to urinate, Dr. Gordon commonly uses both.
When performed by a trained, licensed provider with detailed knowledge of anatomy, it has a strong safety record. Tell Dr. Gordon if you take blood thinners, have a bleeding disorder, are pregnant or have a weakened immune system so he can plan accordingly.
It is a technique that reaches the internal pelvic floor muscles, including the levator ani, obturator internus and coccygeus, to release trigger points and restore normal muscle function. Dr. Gordon holds ASE certification in this technique, which few practitioners in New York have.
Yes. Your privacy and comfort come first. When undressing is needed for the area being treated, you are fully draped, and nothing internal is done without your clear consent. You can pause or stop at any time.
Yes. Straining to urinate can affect people of every gender, and Dr. Gordon treats adults of all genders and identities.
It helps to have had a medical workup so serious causes have been checked. If you have not seen a physician for your pelvic symptoms yet, call the clinic to talk through the best order of steps.
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioBook an Evaluation for Straining to Urinate
Book a full evaluation with Dr. Gordon and find out why your pelvic floor is resisting.
Early morning, evening and weekend appointments available. Free on-site parking.
Further Reading
Enlarged Prostate or Tight Pelvic Floor? Why Urinary Symptoms in Men Are Not Always the Prostate
From the blog: A weak stream, hesitancy and dribbling are often blamed on the prostate. How BPH and a tight pelvic floor differ, why many men have both, and who checks first.