How is urinary dribbling managed?

From the Guidelines

Urinary dribbling can be effectively managed through a combination of behavioral techniques, pelvic floor exercises, and medical interventions, with the most recent guidelines from 2023 emphasizing the importance of a practical assessment and individualized treatment approach 1. The management of urinary dribbling involves addressing the underlying causes, which can include weakened pelvic floor muscles, enlarged prostate, or neurological issues affecting bladder control.

• Behavioral techniques such as the "double voiding" technique, where men urinate normally and then wait a moment before trying to urinate again to empty the bladder completely, can be effective in managing dribbling.
• The "milking" technique, where gentle pressure is applied along the urethra from behind the scrotum to the tip of the penis after urination, can also help expel remaining urine.
• Pelvic floor exercises (Kegel exercises) strengthen the muscles that control urination and should be performed regularly by contracting these muscles for 5 seconds, relaxing for 5 seconds, and repeating 10-15 times, three times daily.
• Absorbent pads or specialized underwear can provide protection against leakage.
• For persistent dribbling, medications like alpha-blockers (tamsulosin 0.4mg daily) may help by relaxing bladder neck muscles, while anticholinergics (oxybutynin 5mg twice daily) can reduce bladder overactivity, as recommended in the 2021 guidelines on the management of lower urinary tract symptoms attributed to benign prostatic hyperplasia 1.
• Lifestyle modifications, such as limiting fluid intake before bedtime, avoiding caffeine and alcohol which irritate the bladder, and maintaining a healthy weight to reduce pressure on the bladder, are also crucial in managing urinary dribbling, as suggested by the 2022 study on the diagnosis and treatment of interstitial cystitis/bladder pain syndrome 1 and the 2013 evaluation and treatment of lower urinary tract symptoms in older men 1.

From the FDA Drug Label

Effect on Symptom Score Symptoms were quantified using a score similar to the American Urological Association Symptom Score, which evaluated both obstructive symptoms (impairment of size and force of stream, sensation of incomplete bladder emptying, delayed or interrupted urination) and irritative symptoms (nocturia, daytime frequency, need to strain or push the flow of urine)

The management of urinary dribbling is not directly addressed in the provided drug label. However, urinary dribbling can be related to obstructive symptoms such as impairment of size and force of stream or sensation of incomplete bladder emptying.

• The drug label discusses the improvement in symptom score in patients treated with finasteride tablets, which includes obstructive symptoms.
• Finasteride tablets have been shown to decrease the risk of acute urinary retention and the need for BPH-related surgery.
• The label also mentions an increase in maximum urinary flow rate in patients treated with finasteride tablets. However, the label does not provide direct information on the management of urinary dribbling. 2

From the Research

Management of Urinary Dribbling

Urinary dribbling, also known as post-micturition dribbling, is a common condition where a small amount of urine leaks out after urination. The management of urinary dribbling can be approached through various methods, including:

• Pelvic Floor Muscle Exercises: A study published in 2001 3 found that teaching pelvic floor muscle exercises to patients after transurethral resection of the prostate can help reduce post-micturition dribbling and improve quality of life.
• Lifestyle Modifications: Lifestyle changes such as weight loss, dietary changes, and fluid intake management can also help manage urinary incontinence, including urinary dribbling 4.
• Behavioral Interventions: Behavioral interventions, including bladder training and pelvic floor muscle exercises, can be effective in managing overactive bladder and urgency urinary incontinence, which can contribute to urinary dribbling 5.
• Medical Treatment: Medical treatment, such as anticholinergics and β3-agonist medications, can be used to manage urgency urinary incontinence, which can contribute to urinary dribbling 6.

Physiological Aspects of Urinary Dribbling

A study published in 2019 7 found that post-micturition dribbling can be regarded as a physiological occurrence in men, rather than a disease by itself. The study found that urine loss after micturition was common in both men with post-micturition dribbling and healthy controls, but the amount of bother and suffering was significantly higher in the post-micturition dribbling group.

Key Findings

• Pelvic floor muscle exercises can help reduce post-micturition dribbling and improve quality of life 3.
• Lifestyle modifications, such as weight loss and dietary changes, can help manage urinary incontinence, including urinary dribbling 4.
• Behavioral interventions, including bladder training and pelvic floor muscle exercises, can be effective in managing overactive bladder and urgency urinary incontinence 5.
• Post-micturition dribbling can be regarded as a physiological occurrence in men, rather than a disease by itself 7.