Self-management can help reduce men’s PMD

by Andrew Binns The technique for this bulbar You may have heard the saying “no for patients is as follows (see matter how hard you shake it the Bladder accompanying diagram): last drop always goes down your leg”. This is the condition called post-micturition dribbling (PMD), common amongst men “of a Pool of urine Rectum ● Pass urine in the usual way then wait a few seconds to allow your bladder to empty. certain age” that probably does not Urethra ● Place the fingertips of your get the attention it deserves. It can hand about 3 finger widths cause considerable distress and even result in the need to change Urethral opening Prostate Pelvic floor muscles behind your scrotum and press gently. wet underwear - or even conceal wet outer-wear. Apply pressure here ● Still applying pressure, bring your fingers towards the base of

For men, gravity and muscle in direction of arrow your penis. weakness are responsible for urinary dribble. The male urethra does not run in a straight downhill line. It has a little dip in the middle of it, creating a pool where urine can collect. Normally, a muscle involuntary loss of urine immediately after urination. It is classified as a postmicturition symptom and is more common in males. Traditionally, PMD has been considered part of the aging process, ● This pushes the urine forward from the bulbar urethra into the penile urethra where it can be emptied by shaking or squeezing in the usual way. called the bulbocavernosus that fits around to have a low prevalence, and to be less ● Repeat this process twice to ensure the urethra will automatically squeeze to bothersome than other lower urinary tract that the urethra is completely empty. force the urine out, but this muscle can lose symptoms (LUTS). ● Practise this technique at home its tone, especially in men older than 50 years. “However, recent evidence suggests ● When in a public toilet it may be that PMD is not less common and does advisable to use a cubicle for more privacy.

Sometimes movement and gravity will not elicit less discomfort compared with (see diagram).cause the last few drops of urine that pool other LUTS in males. Also, PMD seems to up in the dip of the urethra to involuntarily commonly overlap with other LUTS and Note: this procedure can be done through spill out of the body at an unpredictable to be associated with erectile dysfunction. clothing which may be more acceptable for time, leading to those embarrassing wet Although the etiology of PMD is not fully men standing at a urinal. spots. understood, a weakness or failure of the In conclusion, PMD is often ignored

The statistics vary on how common this pelvic floor muscles is considered the as just being on the list of inevitable condition is, with some studies suggesting most important factor. Although bulbar problems as one grows older. It probably it may be over 50% in older men. It urethral massage and pelvic floor exercises deserves more attention and research certainly increases with advancing years. are known to be effective in treating PMD, to find improved treatments. Maybe In an ageing population it is growing in pharmacologic treatment has not yet been there will be medications that help in the prevalence and is often associated with introduced. Recently, the possibility of future, but meantime this simple self-help other lower urinary tract symptoms (LUTS) treating PMD with phosphodiesterase-5 management of bulbar urethral massage and sometimes with erectile dysfunction inhibitor has been suggested.” along with pelvic floor exercises has a vital (ED). When it comes to GP management role to play.

The amount of urine lost is variable. One an appropriate medical history and study shows that in those experiencing ED examination is the first step. Depending on the leakage was approximately 2.1 mls, the findings a referral to a Urologist may be compared with 1.2 mls for those not having indicated. ED. ”Bulbar urethral massage is usually of

PMD can occur in women but less some benefit…” commonly. A good and recent review In regard to treatment there are few article of many studies on this topic can options and the benefits of pharmaceutical be found in the Journal: Investigative and intervention is still not conclusive. Clinical Urology 2019 May; 60(3): 142- However, there is one simple self-help 147 titled, A current perspective on post- procedure that can be taught to patients micturition dribble in males. - bulbar urethral massage. It is usually

The abstract of this paper states: of some benefit and can complement the

“Post-micturition dribble (PMD) is the encouragement of pelvic floor exercises. urethral massage instructions