POST-VOID DRIBBLING:
Dear Sumner:
What can you do with a man who claims he always has a few drops of urine wetting his underpants when he finishes urinating? This is complaint of my 48 year old patient Roger, who has never had any documented urinary tract infections or venereal diseases and is otherwise totally asymptomatic. I have been unable to find any cause for his problem. I would appreciate your input.
Dear Gretchen:
I am optimistic that we have helped Roger solve his problem. I think the underlying basis for the leakage is a disturbance of the coordination of the voluntary and involuntary muscular components of his urethral sphincter, sometimes referred to as “dyssynergia”. Ordinarily these two components contract synchronously. Roger, in a conscious effort to stop the urinary flow, would initiate the voluntary muscle component of the urethral sphincter, perceiving that he had completed the act of voiding. However, before the involuntary muscle component contracted, the small amount of urine “trapped” in the posterior urethra would dribble out spontaneously and soil his pants. (How’s that for an esoteric explanation for a rather common phenomenon?) By relaxing his perineal muscles at the time of perceived completion of urination--possibly allowing time for contraction of the involuntary component--and by applying direct pressure with his finger on the area of his penoscrotal junction, Roger was able to eject those last few drops from the urethra and thereby avoid the embarrassing wet spots on his pants.
