Post-Void Dribbling (PVD)
Andrew Siegel, MD Blog #108
Introduction: Probably the two most common and annoying complaints from my male patients are sleep-disruptive nighttime urination and post-void dribbling. The following is a tiny “taste” of the content of my new book, forthcoming this summer, entitled Male Pelvic Fitness: Optimizing Sexual and Urinary Health.
The Problem: Post-void dribbling is the leakage of urine immediately or shortly after completing the act of urinating. This “after-dribble” is more annoying than serious and can be one of the first manifestations of prostate enlargement. Although it rarely occurs before age forty, it can happen on occasion to men of any age.
Dorey et al published an article in the British Journal of Urology that demonstrated the effectiveness of pelvic floor muscle (PFM) exercises for erectile dysfunction, but also suggested an association between the occurrence of erectile dysfunction (ED) and post-void dribbling. How fascinating—ED and PVD are linked and parallel problems, one sexual and the other urinary—both being manifestations of pelvic floor muscle weakness, and both treatable by increasing pelvic floor muscle fitness.
The Science: The urethra has an external portion within the penis, an internal portion that travels in the perineum (the area of the body between the scrotum and the anus), and an innermost portion, which traverses the prostate and enters the bladder. After urinating, there is always some urine that remains and pools in the internal urethra. When it drips out of the urethra aided by gravity and movement, it is referred to as PVD.
The Premise: Pelvic floor muscle contractions are the body’s natural mechanism for draining the urethra. Improving the strength and tone of the PFM will help eject the contents of the inner, deeper portion of the urethra. When contracted, the bulbocavernosus (BC) muscle compresses this deep portion of the urethra, displacing the urine within further downstream. A powerful BC muscle will substantially help this process, in much the same way that it facilitates ejaculation. The BC is the body’s natural urethral “stripper”; however, the BC does not surround the entire urethra, so it is likely that a strong BC will improve the PVD, although it is possible to still have some drops remaining in the penile urethra.
The Solution: Try not to rush the act of urination. The adage “haste makes waste” is absolutely relevant with respect to PVD. When finished urinating, vigorously contract the PFM several times to displace the inner urethra’s contents. If necessary, the urethra of the penis can be further evacuated of urine by manually compressing and stripping it. To do so, starting where the penis meets the scrotum, compress the urethra between your thumb on top and index and middle fingers on the undersurface and draw them forth towards the penile tip, “milking” out any remaining urine. To further improve the PVD, gently shake the penis until no more urine drips from the urethra. It is not a bad idea to apply tissue to the tip of the penis to soak up any residual urine—women have the right idea here.
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
Available on Amazon in paperback or Kindle edition
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