Post-Micturition Dribble
The term for when a male urinates and then experiences additional urine leakage after completion of voiding is "post-micturition dribble" (PMD). 1, 2
Definition and Clinical Characteristics
Post-micturition dribble is defined as the involuntary loss of urine immediately after urination, typically occurring after the male has left the toilet. 1, 2
This symptom is classified as a post-micturition symptom rather than a voiding (obstructive) symptom or storage symptom, though it can overlap with both categories depending on the underlying cause. 1
PMD occurs because residual urine becomes trapped and pooled inside the bulbar urethra after voiding is complete, and this urine then drains down the urethra after the patient has finished at the toilet. 3
Pathophysiology
The most important etiologic factor is weakness or failure of the pelvic floor muscles to adequately expel urine from the bulbar urethra. 2
In elderly men with benign prostatic hyperplasia, PMD usually implies incomplete bladder emptying and is considered part of voiding dysfunction. 1
However, in many patients—even those with bladder outlet obstruction—PMD is often considered a form of urinary incontinence (storage symptom) rather than purely a voiding problem. 1
Clinical Significance and Prevalence
Contrary to traditional teaching, recent evidence demonstrates that PMD is not less common and does not elicit less discomfort compared with other lower urinary tract symptoms in males. 2
PMD commonly overlaps with other lower urinary tract symptoms and is associated with erectile dysfunction. 2
PMD affects men of all ages but is predominantly found in older patients. 3
Diagnostic Approach
When PMD is present, perform detailed history taking to distinguish whether it represents incomplete emptying (voiding dysfunction) versus incontinence (storage dysfunction). 1
Obtain uroflowmetry, post-void residual volume measurement, and consider comprehensive urodynamic evaluation if the clinical picture is unclear or if significant lower urinary tract symptoms coexist. 1
If no urodynamic abnormalities of either the detrusor or the outlet can be detected despite significant symptoms, factors unrelated to the lower urinary tract may be responsible. 1
Treatment Options
Bulbar urethral massage (milking the urethra from the base of the scrotum forward after voiding) and pelvic floor exercises are known to be effective treatments for PMD. 2
Pharmacologic treatment has not yet been formally introduced, though recent evidence suggests the possibility of treating PMD with phosphodiesterase-5 inhibitors. 2
Many men attempt to manage PMD by placing absorbent materials in their underwear, unaware that effective treatments exist and that continence advisers can provide guidance. 3
Common Pitfalls
Do not automatically assume PMD in an elderly male represents benign prostatic hyperplasia without proper evaluation—the symptom can occur in men of all ages and has multiple potential causes. 2, 3
Do not dismiss PMD as a minor or inevitable part of aging—it can be significantly bothersome and warrants evaluation and treatment. 2
Recognize that PMD may indicate incomplete bladder emptying in some patients, requiring measurement of post-void residual volume to rule out significant retention. 1