Why do I have two streams of urine?

Dear Am I Normal,

Two questions, one for each stream! To start, there are many reasons why you may be noticing two streams of urine, otherwise known as “spraying” or “splitting.” While having two streams isn’t necessarily related to prostate cancer, it's never too early to think ahead about when you should start taking those next steps.

Two streams of urine could be caused by many factors, some potential reasons why this may be happening include:

Meatal stenosis – this can occur when the meatus—urethral opening—is narrow. Although commonly seen in young children after circumcision, it can also be seen in adults due to certain factors like the overuse of urinary catheters or other urethral insertions.

Urethral stricture – this is a type of scarring that causes the urethra—the tube that carries urine from the bladder to the meatus—to narrow, eventually restricting the flow of urine from the bladder. This condition is often caused by the insertion of items into the urethra, as well as trauma or cancer of the urethra, pelvis, or prostate, or sexually transmitted infections (STIs).

Phimosis – also known as having a tight foreskin, Phimosis, can cause urine ‘splitting’. This condition is typically caused by poor hygiene, certain skin conditions like psoriasis, STIs, or injury to the penis.

Congenital anomalies – otherwise known as birth defects, congenital anomalies that may cause two streams of urine include congenital urethra fistulas and urethral duplication. A congenital urethral fistula occurs when a passage, otherwise known as the fistula, has developed between the urethra and the penile skin. Urethral duplication occurs when a person is born with two urethras and has either two openings (for outflow of urine), or two urethras with one joined opening.

Prostate enlargement – an enlargement of the prostate can often squeeze or block the urethra, which can then affect urination and contribute to a split stream. While an enlarged prostate isn’t a direct link to prostate cancer, it may be wise to speak with a health care provider about being screened, considering your symptoms and family history.

Although none of these conditions are life-threatening on their own, they could lead to more serious health concerns in the future. Untreated meatal stenosis may cause urinary tract infections or kidney conditions if urine is unable to properly exit the body. You may also experience pain while urinating, swelling of the penis, or erectile pain during sexual activities. To understand exactly what’s causing you to have two streams, it’s recommended that you speak with a health care provider to get a proper diagnosis. If it turns out that you do have a medical issue contributing to your double stream, it may be reassuring to know that there are many treatment options available, ranging from steroid creams to surgery. There's also a chance that they’ll tell you it's just a harmless quirk, in which case, you at least took the steps to get everything checked out!

Moving onto your second question, it may be helpful to first provide some background information regarding prostate cancer. Prostate cancer is a type of cancer that’s found in the prostate gland. This gland is located under the bladder and is responsible for producing fluid to nourish and support sperm movement for conception. Symptoms of prostate cancer often include frequent urges to urinate, painful urination, urinary or fecal incontinence, painful ejaculation, erectile dysfunction, or blood in the semen or pee. Some risk factors for prostate cancer can include:

Age. Risk tends to increase with age.

Race and Ethnicity. Individuals who are Black or have African ancestry are at higher risk of prostate cancer, especially before 50 years old.

Family History. Having a family history of prostate cancer may increase the risk of developing the condition.

Genetic conditions. Individuals with Lynch syndrome or a family history of breast cancer that was caused by a mutation in breast cancer gene one or gene two (BRCA1, BRCA2) have a greater risk of prostate cancer.

Other potential risk factors. Mixed evidence also suggests that smoking tobacco, prostatitis—having an inflamed prostate—obesity and exposure to agent orange may also increase someone's risk of prostate cancer.

Screening for prostate cancer typically begins between the ages of 50 to 55, with higher risk individuals beginning at around 45 years old. However, given your family history, you might consider scheduling an appointment with a health care provider to talk about your risk for prostate cancer and how it may relate to your urinary situation. A provider may suggest beginning screening earlier, rather than later. To gain a better understanding of what to expect during screening, consider reviewing Screening for Prostate Cancer guidelines outlined by the Center for Disease Control and Prevention (CDC).

Finally, there are prevention strategies you might choose to employ that may reduce your risk of prostate cancer such as:

Getting screened regularly. Getting screened every one to three years, depending on your individual risk factors, may allow health care providers to catch any possible diseases in their early stages, which may lead to faster treatment.

Exercising regularly. Incorporating a moderate amount of physical activity—at least 30 minutes daily—may improve overall health and reduce the risk of obesity.

Eating a variety of nutrient rich foods. Eating a balance of fruits, vegetables, and whole grains may also improve your overall health and provide your body with the vitamins it needs to support itself.

Avoiding the use of tobacco products. Because tobacco can cause damage to deoxyribonucleic acid (DNA) or affect hormone levels due to its carcinogenic properties, it’s often recommended to avoid smoking or chewing tobacco.

Consider checking out the American Cancer Society for more information on causes, risk factors, prevention strategies, and treatment options. Hopefully, with this information, you’ll begin to have some peace of mind.