Andrew Siegel MD 2/17/2024
Note: This entry is intended for men, although women may also experience this problem.
I’m not sure who is responsible for this adage that rings true: “No matter how much you shake and dance, the last few drops end up in your pants.” Alternatively, the UK version is: “No matter how much you shake your peg, one drip always goes down your leg.”
To help understand this situation, let’s start with some basic facts:
— The outer half of the urethra (the channel that conducts urine from the bladder) is within the penis, whereas the inner half runs in the perineum (the area between scrotal sac and anus), through the prostate, and then attaches to the bladder neck.
— No one empties their bladder 100% completely, with rare exception.
— After urinating, there is often a small amount of residual urine left within the inner (perineal) urethra, the most capacious part of the urethra.
— The muscle that surrounds the inner urethra that is responsible for compressing the urethra and draining it of its contents (whether urine or semen) tends to weaken with the aging process, as do many other skeletal muscles.
PVD (Post-Void Dribbling) is an after-dribbling of urine that is more annoying and embarrassing than serious. Although it commonly occurs after age forty, it can happen to men of any age. Immediately or shortly after completing urination, residual urine that remains pooled in the urethra drips out, aided by gravity and movement. If you find yourself needing to wear dark slacks, blow dry, fan or use those high-powered turbo hand dryers on your pants after urinating, place tissues within your underwear, or need to tuck your shirt in strategically to provide an additional layer between your underwear and pants, this entry will certainly benefit you!
PVD is most often caused by residual urine retained in the deeper, inner part of the urethra referred to as the bulbar urethra. It is the most expansive and capacious part of the urethra with the widest diameter and is located within the perineum, the area of the body that is in contact with a bike seat when cycling. The more superficial, outer part of the urethra is known as the penile urethra.
A specific pelvic floor muscle, the bulbocavernosus muscle (referred to in the diagram below as BC muscle), is responsible for compressing the bulbar urethra and thus ejecting its contents, whether urine or semen. The 1909 edition of Gray’s Anatomy textbook referred to the BC muscle as the “ejaculator urine” for good reason. With aging and loss of pelvic floor strength and power, it is not uncommon for men to experience PVD, as well as ejaculatory dysfunction that can be manifested with a decreased ejaculate volume, force, trajectory, and sensation. Sadly, this translates into urine sometimes dribbling out after voiding and semen oozing instead of being forcibly ejaculated.
If you are experiencing both PVD and erectile/ejaculatory issues, the common denominator just might be weakened pelvic floor muscles.
Ways to Do to Deal with PVD
- Don’t rush urination. Urologists interpret “haste makes waste” as “haste makes PVD.” So, loosen your belt, unbutton and unzip your trousers, take aim and be patient. Make every effort to be focused, attentive, and mindful about emptying your bladder as completely as possible.
- Contract your bulbocavernosus muscle after finishing urinating. When you feel that you have completed the act of urinating, vigorously and rhythmically contract your BC muscle (as if you are ejaculating) at least five or so times to displace the urine within the inner urethra. This will help propel out the last few drops of urine, which will be directed into the toilet and not on your clothing.
- Strip the urethra. If necessary, bulbocavernosus contractions can be supplemented with manually compressing and stripping the urethra. To do so, begin in the midline beneath the perineum and use the index and middle fingers of your dominant hand to compress the urethra, proceeding from the perineum to the undersurface of the scrotum through the full length of the penis, “milking” out any remaining urine. It is similar to stripping a tube of toothpaste to get every last bit out.
- Shake and wipe. Gently shake the penis until no more urine drips from the urethra. Don’t hesitate to use a tissue to soak up any residual urine (the fairer sex has the right idea here).
- Pelvic floor strengthening exercises. These have been proven to be an effective remedy for helping to combat PVD, with the premise that a stronger and more powerful BC muscle will help in ejecting the contents of the urethra. Not only can pelvic training optimize urethral emptying, but also has the bonus of potentially improving erections and ejaculation.
Aides to help strengthen the pelvic floor muscles include the Male Pelvic Fitness book and the PelvicRx pelvic training DVD, a follow-along exercise program that is well-designed, easy to use and interactive. The intent is to optimize the strength and power of the pelvic floor exercises by providing education, guidance, training, and feedback to confirm the engagement of the proper muscles. It is structured so that repetitions, contraction intensity and contraction duration are gradually increased over the course of the 4-week program. This progression is the key to maximizing pelvic strength and endurance.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. His mission is to “bridge the gap” between the public and the medical community.
He is an Assistant Clinical Professor in the Department of Urology at Hackensack Meridian School of Medicine and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. He is a urologist at New Jersey Urology, a Summit Health Company. He is the co-founder of PelvicRx and Private Gym.
Dr. Siegel is the author of several books. The newly revised second edition (June 2023) of Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now available in print and Kindle formats on Amazon.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Dr. Siegel’s other books:
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food
Our Greatest Wealth Is Health 