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DocSpot: Not peeing straight

Dear Dr Margaret

I had an e-mail from a man who is unable to pee straight, which was both annoying and very embarrassing, particularly when using a public toilet. I didn't know the reason for this, so I asked Dr Julian Shah, who is Consultant Urologist at the Institute of Urology and Nephrology in London. Dr Shah explained that if you look carefully at the stream of urine as it leaves the penis, you will notice that it comes out as a spiral. This is because of the structure of the urethra (the tube inside the penis that the urine passes through). The urethra is slightly flattened horizontally, but its opening at the end of the penis (the meatus) is a vertical ellipse shape. This gives the urine a twist as it emerges and, paradoxically, the twist keeps the urine in a single stream.

Obstructed flow

Anything that distorts the way the urine flows will affect the way the stream comes out of the penis. It is quite common to experience occasional deviation or spraying. For example, if there is a little stickiness at the meatus, the stream can come out in two streams or as a spray. This is nothing to worry about if it happens only infrequently.

Is your opening in the wrong place?

However, Mr Shah says that there are some conditions that can cause this sort of problem every time you pass urine. One of them is hypospadias, in which you are born with the hole (meatus) in the wrong place. Instead of being at the tip of the penis, it is often just underneath (see Penis - opening in the wrong place). Hypospadias is usually noticed at birth and corrected by surgery, but the scarring that occurs as the wound heals may mean that the meatus does not have the desired vertical ellipse shape. As a result, some spraying may occur.
Also, problems inside the urethra, such as an abnormal narrowing (stricture) or scar, can distort the flow and reduce its force. And if you have weak bladder muscle, you may have to strain to pass urine, which can cause spraying.

Don't be shy...

So Dr Shah's advice to anyone who is having problems with spraying of urine or a wonky stream is to overcome your embarrassment and visit your GP. It is a problem that needs to be sorted out, and your GP will be able to examine you and refer you to a urologist if necessary.

Last updated; Sunday, August 30th 2020

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