Hey Doc, of recent, I have been having this splitting of urine which is of concern to me. What baffles me is that it doesn’t happen all the time I urinate, and also it tends to occur less when I am well hydrated. Please your advice will go a long way. Thanks Dr Ketch

A: A split stream of urine is typically caused by urinary obstruction. Some conditions that can lead to this include problems of the prostate gland and urinary strictures.

A urinary stricture is the narrowing of the urethra (the tube that leads urine out of the body). This, naturally, leads to restriction of the flow of urine out of the body leading to a variety of medical problems.

This condition is more common in males than females because of the position of the urethra and although sometimes the cause is unknown, common causes include

• Straddle injury (falling astride an object),
• Endoscopy (a procedure in which an instrument called a probe is inserted into the urethra)
• Prolonged use of a catheter
• Trauma or injury to the urethra or pelvis
• Sexually transmitted infections
• Cancer of the prostate or urthra
• Prostate enlargement
• Previous prostate surgery

The prostate gland is a small organ located just below the bladder. It produces semen and the urethra which transports urine from the bladder and semen from the prostate, passes through the prostate. This organ grows throughout a male’s life and sometimes grows so big that it blocks the flow of urine from the bladder. This condition is known as Benign Prostatic Enlargement or Benign Prostatic Hypertrophy or Benign Prostatic Hyperplasia. This is more likely to happen as people age and when there is a family history of this.

The symptoms of this are also typical for urinary strictures and include

• Feeling like urinating very frequently
• Feeling the need to urgently urinate
• Not being able to start urinating immediately despite the urgency
• Straining at urine
• When the person does start urinating, the flow trickles 
• Split stream of urine
• Feeling that the bladder was not completely emptied
• Urinary tract infections due to the fact that there is always urine in the bladder encouraging the growth of micro-organisms
• Bladder stones
• With time, kidney function becomes reduced

These are some of the symptoms that may bring the person to the hospital. The doctor will perform a detailed examination which include a rectal examination and order an array of tests.

Treatment modalities include medications and surgery. The doctor will determine which works best for you.

Prostate-friendly diets include loads of fruits and veggies and less fat in the diet. Exercising daily and limiting alcohol intake are also thought to be helpful.

Having said all this, the first thing you need to do is to go see your doctor and get yourself checked out.

All the best!