Many men, young and old, are troubled by the dribbling of urine after the main stream has stopped and the bladder feels empty. Even if they wait a moment and shake the penis before zipping up, there can be embarrassing wet or stained trousers. At highest risk: men with enlarged prostates.
The medical term for this is post-micturition dribbling. It occurs when the muscles surrounding the urethra don’t squeeze hard enough for it to empty completely, leaving a small pool of urine at a dip in the urethra behind the base of the penis. Within a few minutes, the urine dribbles out. In women, dribbling can occur when a little urine gets trapped in the vagina, dripping out when you stand up from the toilet. Wipe inside the vagina before standing to see if this eliminates the dripping.
Many men develop bladder control problems as they get older. But urine leakage, frequent urination, or the urgent needs to urinate don’t have to be unavoidable parts of ageing. Bladder control problems can be treated.
Men can have several types of bladder control problems.
- Urinary incontinence (UI) is the accidental leakage of urine. Urine can leak in three ways:
- when you cough, sneeze, or lift-actions that put pressure on the bladder
- sudden strong urge to urinate
- constant dribbling. Men with this problem usually need to urinate often and only pass small amounts of urine each time.
- Overactive bladder is a condition in which the bladder squeezes urine out at the wrong time. You may have overactive bladder if you have two or more of these symptoms:
- urination eight or more times a day or two or more times at night
- the sudden, strong need to urinate immediately
- urine leakage that follows a sudden, strong urge to urinate
UI and overactive bladder may be caused by prostate or nerve problems. Sometimes the cause of overactive bladder is not clear.
The prostate is a male gland about the size of a walnut that surrounds the urethra, the tube that carries urine and semen out of the body.
An enlarged prostate, common among older men, may squeeze the urethra and result in a weak urine stream, an urgent need to urinate followed by leakage, and frequent urination, especially at night.
Surgery or radiation to treat prostate cancer can lead to temporary or permanent bladder control problems.
Nerve problems. Damaged nerves may send signals to the bladder at the wrong time or send no signals at all, leading to bladder control problems. Spinal cord injuries or conditions such as diabetes or stroke may cause nerve problems.
How the incontinence affects you depends on what is causing it. For this reason it is important to seek professional help from a doctor so the cause can be found and appropriate treatment given.
Urine flow problems
One in three men over 50 years of age experiences some difficulty in passing water. The way men pass water changes gradually as they get older, so at first they may not notice there is a problem. Typical changes include:
- difficulty or delay in starting to pass water. The first step in starting the flow is to relax the muscles under the bladder in the pelvic floor. Delay in starting is common with ageing, and with prostate problems, but it can also be due to shyness if voiding in a public toilet. This affects about 30% of men, who have no problems passing urine in private.
- stopping and starting in the middle of passing water
- a smaller and weaker urinary stream, so it takes longer to pass water than it used to. It may also stop and start and as the bladder empties, the flow can slow down to just a trickle. This is called ‘terminal dribble’
- after finishing, a bit more urine trickles out. After the flow stops and the man has adjusted his clothes, a few more drops can come out and can cause an embarrassing wet patch on the trousers. This is due to urine pooling in the water pipe (urethra). It can be prevented by making sure there is nothing pressing on the urethra, like tight clothing or zips. The drips can be helped by milking the water pipe using the fingers.
- a feeling of not quite having emptied the bladder. This symptom sometimes indicates the presence of residual urine, but is not always accurate at predicting this.
Some, or all, of these difficulties in passing water can happen because in most people over the age of 40, the prostate gland gradually becomes enlarged after 40 years of age. The difficulties caused by BPH can be relieved by medication or if necessary by surgery. Men with flow rates under 15 should talk to a health professional.
What is the milking technique for preventing dribble?
Wait a few seconds after passing urine for the bladder to empty completely. Place the fingertips of one hand under the scrotum (approximately three finger-breadths) and apply gentle upward pressure. Keep the pressure on the midline and firmly move the fingers forward towards the base of the penis under the scrotum. This milks urine forward in the urethra where it can be emptied by shaking or squeezing in the usual way. Repeat this technique twice to ensure complete emptying.
Increased frequency of bladder emptying
This refers to passing urine more often than usual in the daytime, and if there is also a need to get up at night, this is termed nocturia.
- Fluid amount and type: Increased volumes of urine can be the cause. Drinking large volumes of fluid especially tea, coffee, chocolate drinks, or alcohol in the evenings, will mean a person has to empty the bladder more often.
- Cold: Cold weather makes the bladder more irritable.
- Diuretics (‘water’ pills): Diuretic medications like furesemide, prescribed for blood pressure or heart failure, can cause increased frequency. These tablets are best taken in the morning to allow time to get rid of the extra water in the body.
- Overactive bladder: Increased frequency can also arise simply because of an effect of ageing on the kidneys and bladder. An overactive bladder can be the cause
What can I do about bladder control problems?
Just changing some daily habits may help. For example, you could limit fluids at certain times of the day or plan regular trips to the bathroom to avoid an accident.
Try these approaches to avoid wet and stained trousers:
- Practice pelvic floor exercises to increase muscle strength.
- “Milk out” the last few drops of urine. This maneuver should move the pooled urine into the penis, where you can shake out the last few drops. With practice, you should be able to do this quickly and unobtrusively.
- Don’t be embarrassed to talk with your doctor about your problem. Your doctor may prescribe medicine to calm abnormal nerve signals to the bladder. Other medicines relax the bladder or shrink the prostate. Surgery can help bladder control problems caused by nerve damage.
Toned pelvic floor brings benefits
Doing pelvic floor muscle exercises should help improve continence problems in men, as a toned pelvic floor helps support the bladder and bowel. The exercises should be practiced regularly, and it may take some weeks for the benefit to be seen. See your doctor for a medical check and advice if urinary symptoms do not improve.
The pelvic floor is the layer of muscle stretching from the pubic bone in the front to the tail bone at the back and forming the floor of the pelvis. It is the main support structure for the pelvic organs.
- a toned pelvic floor supports the bladder and bowel
- a toned pelvic floor helps close off the bladder and bowel outlets to help prevent leakage, and relaxation of the pelvic floor allows effective bladder and bowel emptying
- a functional pelvic floor may enhance the ability to maintain an erection.
Factors contributing to pelvic floor muscle weakness
- some types of prostate surgery
- neurological problems
- Parkinson’s disease
- urinary retention
- persistent training to empty the bladder or bowel with or without constipation
- persistent heavy lifting
- a chronic cough (from smoking, chronic bronchitis or asthma)
- being overweight
- lack of regular exercise
Once the pelvic floor muscles (see diagram below) become weak, your ability to hold urine and / or wind during physical activity is compromised. Like any other muscle of the body the more you use and exercise them, the better they will function.
The first step is to correctly identify the muscles. Sit comfortably – your thighs, buttocks and tummy muscles should be relaxed. Lift and squeeze inside as if you are trying to hold back urine, or wind from the back passage.
- If you are unable to feel a definite squeeze and lift action of your pelvic floor, don’t worry. Even people with very weak muscles can be taught these exercises.
- If you feel unsure whether you have identified the correct muscles, try to stop your flow when passing urine, then restart it. Only do this to identify the correct muscles to use – this is a test, NOT an exercise.
- If you are unable to feel a definite tighten and lift action in your pelvic floor muscles you should seek professional advice.
At first you may need to perform these exercises while sitting. As the muscles strengthen you can progress to exercise standing up. Like any activity, start with what you can achieve and progress from there. Remember to use your muscles whenever you exert yourself during your daily activities.
If you can feel the muscles working, exercise them by:
1. Squeezing/ tightening and drawing in and up around both your anus (back passage) and urethra (bladder outlet). Lift up inside and try to hold this contraction strongly for as long as you can (1 – 10 seconds). Keep breathing! Now release and relax. You should have a definite feeling of letting go.
2. Rest 10 – 20 seconds – repeat Step 1, and remember it is important to rest. If you find it easy to hold, try to hold longer and repeat as many as you are able. Work towards 12 long, strong holds.
3. Now try 5 – 10 short, fast strong contractions.
- do NOT hold your breath
- do NOT push down instead of squeeze and lift
- do NOT pull your tummy in tightly
- do NOT tighten your buttocks and thighs.
Try to set aside 5 – 10 minutes in your day for this exercise routine, and remember, quality is important. A few good contractions are more beneficial than many half-hearted ones and good results take time and effort. Remember to use the muscles when you need them most. That is, always tighten before you cough, sneeze, lift, bend, get up out of a chair, etc. Increase the length of time and number of holds you do in succession before experiencing muscle fatigue. Work towards 12 long, strong holds. Increase the number of short, fast contractions – always do your maximum number of quality contractions.
Some helpful hints
- keep your weight within a healthy range for your height and age
- seek medical advice for chronic cough
- develop good bowel habits
- you should anticipate that improvement in pelvic floor muscle strength will take 3 – 6 months of regular training of the muscles.