Post Micturition Dribble: Why does the Urine Leak?

Many people experience the phenomenon of urine leak after voiding. The typical patient is a male, and the typical scenario is that as the patient has just finished urinating and is putting on his underwear, a few drops of urine escape. Although post-micturition dribble occurs also in females, it is more common in males and occurs predominantly in older patients. It has been identified as the most common type of male urinary incontinence.

Post-micturition dribble, also referred to as the after-dribble, is a notoriously embarrassing occurrence that can wet the patient’s pants after every trip to the bathroom. In the beginning, the patient erroneously assumes that he can avoid the embarrassing urine leak if he shakes the penis so as to “empty” it. He may even try straining at the end of micturition in order to squeeze out those last few drops, but all to no avail. These efforts fail because the urine that is leaked after urination is over is not actually present in the penis at the patient evacuates his bladder. It is located higher up in the urethra, at the U-shaped junction between the penile urethra and the bladder. The part of the urethra known as the bulbar urethra, named after the adjacent bulbospongiosus muscle. Normally, the bulbospongiosus muscle, part of the pelvic floor muscles, contracts at the end of micturition to expel the urine which has pooled in this part of the urethra. When this muscle has been weakened, it does not contract properly and the urine is later expelled while redressing or some time later. This muscle can be weakened by excess weight, operation for removal of the prostate, chronic cough, and chronic constipation because of the associated excessive straining.

As a part of the pelvic floor muscles, the bulbospongiosus muscle can be strengthened through Kegel exercises. While performing Kegel exercises, it may be challenging to correctly identify the right muscles at first. Some patients cannot correctly identify which muscles to contract except with the help of a continence expert. It usually helps to try to imagine passing a stream of urine and then interrupting it in the middle without contracting the abdominal or leg muscles. The muscles identified during this exercise are the pelvic floor muscles. Performing several squeezes of the pelvic floor muscles four to five times per day is an excellent rehabilitative measure for the bulbospongiosus muscle. It may take six to nine months, however, for an improvement to be noted.

Another technique taught to patients seeking relief from the post-micturition urine leak is the urethral milking, also known as the bulbar urethral massage. The patient is instructed to place two or three fingers behind his scrotum after urination and massage in a forward and upward direction. This empties the bulbar urethra and allows the patient to squeeze out and pass the last few drops of urine left. Squeezing the pelvic floor muscles immediately before massaging the bulbar urethra has been proven to significantly help in eliminating the post-micturition urine leak.

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Filed under: Urinary Incontinence

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