Should I be concerned

Patient: Don’t know quite how to explain this: Roughly within the last 4 months or so I have noticed during urination that I am no longer able to push the urine out. I just have to let gravity take its course. I am a male and only 38 and was wondering if I should be concerned. There is no pain involved; I am just unable to “increase” the flow.

Doctor: To increase urinary flow requires an increase in the intra-abdominal pressure. This increase in intra-abdominal pressure is usually achieved by pulling in the abdominal wall muscles as if straining to pass stool. This places additional pressure on the bladder and thus increases the pressure within the bladder increasing urinary flow. Not being able to perform this maneuver is not a cause for concern.