Ever wondered why there is a leak after you pee? Post void dribbling is the leakage from the bladder after urination and before the ...

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Urologist Explains Everything You Need to Know about After-Dribble | Post-Void Dribbling

have you ever had a little urine just leak out after you finished going to the bathroom well I'm Dr Reena Malik urologist and pelvic surgeon and today we're going to talk all about postvoid dribble also known as after dribble now postvoid dribble is essentially the involuntary leakage of urine that occurs after you finish going to the bathroom for men it's often when they walk away from the toilet or for women when they stand up from the toilet they may notice a little bit of dribble now this is a really underst studied area and we we know that about somewhere between 8% to 63% of men experience postvoid dribble and in fact in men who have issues after urination this is the most common complaint with over half of men complaining of dribbling urine after they finish urinating so what causes this now the most common cause of this is usually an enlarged prostate so the prostate is a walnut-shaped organ that sits underneath the bladder and around the urethra and as it enlarges it kid narrow the urethra and this can cause urine to get trapped behind the prostate that doesn't all come out easily when you urinate and so this can lead to a little urine slowly dribbling out into the urethra and then later dribbling out after you finish the stream the second cause is sort of related but it could be a narrowing elsewhere in the urethra so if you have a narrowing somewhere again this can cause trapping of urine behind that narrowing that can then dribble out after the urine stream now the the other theory of why this happens is really unknown and the thought is that maybe the muscles surrounding the urethra have gotten weak due to age or that there's been neurologic changes or what we call neuromuscular changes in those muscles making them less effective at expelling urine or pushing it out of the urethra and emptying completely now I've talked about posto dribble or after dribble previously on a video but I wanted to make this video because a systematic review was recently completed and they looked at all the studies about postvoid dribble up until June 2023 and essentially they wanted to look at men who had post mition dribble or postvoid dribble and see if they offered a treatment option and how effective it was and when they did a search of all these studies they found four randomized control trials are essentially trials where they have a treatment group and a placebo group meaning a group that either gets nothing or gets a fake treatment to compare the efficacy of the two now of these four articles two did something called pelvic floor muscle exercises and two offered treatment with a medication called the pde5 inhibitor which is also used for erectile dysfunction now the pelvic floor muscle exercises are in theory strengthening those muscles around the urethra to help expel urine better so you don't have that dribble now the first study had three groups one was a control group where they gave some information about lifestyle modification the second group had pelvic floor muscle exercises and the third group had something called urethral milking and this was done in Australia and each group had about 15 people and they followed these people for about 13 weeks now in these pelvic floor muscle exercise groups they basically went through different strength training exercises to increase the strength of the pelvic floor they also made sure that they did both fast twitch and slow twitch muscle fiber exercises and they assessed their improvement over time and follow these patients for about 13 weeks now remember there was a third group that did ureal milking now what is urethal milking well it's essentially putting your fingers two fingers in the perineum underneath the scrotum and pushing towards the base of the penis to help milk out any urine that might be in the urethra because the urethra is not only in the penis but also goes down into the perineum or also known as the taint the area between the scrotum and the anus now essentially people recommend doing this after urination to help get out any Remnant urine now the other group was done in the UK and very similarly was ascribed to pelvic floor muscle exercises compared to just normal lifestyle changes so in that first study in Australia they measured pad weight so they actually had them wear a pad and they measured how much urine leaked out in the pad for a period of 4 hours before the intervention and then after after and what they saw was that those in the control group had no change in the linkage those in the pelvic floor muscle exercises saw a decrease in about 4.7 g less than what they had at Baseline and the urethal milking group also saw a decrease although it was a little bit less it was about 2.9 G Less on the pad weights now the other study that was done in the UK that was just Lifestyle Changes compared to pelvic floor muscle exercises they didn't measure pad weights but they asked patients did you have any postmar dribble at 6 months and what they found was that about 75% of people in the pelvic floor muscle exercise group had Improvement at 6 months whereas the lifestyle change group had no change now the other two studies looked at giving either a low dose of tadalfil 5 milligram every day or UD denail which is another pd5 inhibitor which is not available in the United States daily as well to patients who had postm dribble now they studied these patients using a standardized questionnaire that's used for postm duration dribble now there's only one questionnaire it's got about five questions and it's only validated in a few countries but they use this questionnaire to assess if there was Improvement as well as pad weights now one of these studies measured pad weight by the volume or the amount of milliliters of leakage of one minute after voiding the other one used a folded up paper towel in the underwear and measured how many grids got wet so these are not exactly perfect measures and so there are some limitations but they both saw a significant decrease in post mition dribble now does a significant decrease actually translate to a meaningful clinical Improvement is hard to say now the urethra corpa cavernosa reflex is essentially when urination occurs it causes the corpa cavernosa to relax and also causes the isio cavros muscles to contract and this can allow for more active emptying of the urethra and this is because the muscles are Contracting but also the relaxation of the corpa allows the urethra to get a little bit more relaxed and maybe wider potentially to let urine flow even better now ultimately these are small studies again most of them were less than 60 people and again there was definitely some limitations in the studies based on how they measured things and were these actually clinically significant But ultimately what what can you do if you're struggling with postvoid dribble well first and foremost you can easily try your rethal milking meaning putting gentle pressure in the perineum or the space between the scrotum and the anus and pushing forward towards the base of the penis to see if that will help milk out the urine that's easy to do may help you and you might not have any issues at all the next thing you want to do is make sure you see a urologist to get assessed for if you have an enlarged prostate or a urethal narrowing now these can be very well treated by a variety of things and if you want to learn more about them check out my videos on enlarged prostate or urethal stricture where I talk about how Johnny Knoxville had a urethal stricture and so you can learn a little bit about that but essentially these are very treatable things that can really improve your quality of life if you're having issues with dribbling urine now the next thing you could do is try to do pelvic floor muscle exercises now these essentially are exercises to strengthen the pelvic floor these are things like Keele exercises where essentially it's sort of the feeling like when you stop urine from flowing so if you're peeing and you're try to stop the flow you are actually using those pelvic floor muscles to contract now you don't want to make a habit of doing this while you urinate so other things you can think of is trying to lift your penis up without touching it or feeling like you're trying to hold in a fart but you don't want to be squeezing your abdominal muscles or your gluteal muscles so sometimes this requires is that you learn how to do this with a pelvic floor physical therapist now thank God for YouTube because there's lots of pelvic floor physical therapists on here who are teaching you how to do keegle exercises if you don't have access to one also if you start having pain after doing these exercises now that could be pain at Baseline or pain with ejaculation or erection or you start noticing that there are more changes in your urine or your bowel movements or maybe your back stop the exercises and come see your urologist ol to get evaluated because you could be tensing up your pelvic floor too much and not relaxing enough leading to dysfunction okay well I hope you guys found this video extremely helpful and if you missed it I wanted to let you know that we are seeing patients now in Beverly Hills as well as Newport Beach California so feel free to make an appointment at www.ram Malik md.com appointments and if you enjoyed this video please be sure to share this Channel with your friends and check out my recent video on preventing enlarged prostate or preventing BPH now as always I'm going to take care of yourself because you worth it

Dr.

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