WHEN TO SEE YOUR DOCTOR
* Dribbling advances from a couple of drops after urination to a leak that's difficult to control.
* You are also experiencing genital discomfort, a burning sensation when you urinate or frequent urges to urinate.
What Your Symptom Is Telling You
Basketball players are supposed to dribble. You're not.
Unfortunately, some people do dribble a little—a little urine, that is. But they shouldn't worry. If it's not more than a few drops, it usually isn't a sign of a serious health problem. And it's often easy to correct.
Before we proceed, let's define what dribbling isn't. We're not talking about incontinence, the outright inability to control your bladder. By dribbling, we mean that little extra urine that almost inevitably seems to trickle out after you have deliberately tried to stop the flow or those little wet spots you unexpectedly feel in your underwear.
A couple of built-in obstacles interfere with the flow of urine from the bladder through the urethra and out of the body, according to Kevin Pranikoff, M.D., associate professor of urology at the State University of New York at Buffalo. In men, urine has a tendency to pool in the bulbus urethra, the widest part of the urethra near the base of the penis.
In women, urine also might pool in the urethra, but more commonly, female anatomy creates the potential for pooling outside the urethra, according to Tamara G. Bavendam, M.D., assistant professor of urology and director of female urology at the University of Washington Medical Center in Seattle. The labia may trap some escaping urine, damming it up into the vagina. In girls, the hymen may block urine. And in women of any age, other folds of pelvic skin, even in women who aren't especially overweight, may interfere with a free flow. "Depending on the woman, there may be several inches of skin from the opening of the urethra to the outside of the body," Dr. Bavendam says.
Poor form can compound the natural obstacles, according to Dr. Pranikoff. Men constrict the flow of urine when they expose their penises over the top of their pants or underwear instead of through their fly. And women obstruct the flow when they don't pull their panty hose down far enough to allow them to spread their legs. The result: A little urine may pool in the vagina and leak out later.
But even with exquisite urinary etiquette, if you have lax pelvic floor muscles, you'll be at a disadvantage in trying to internally clamp off the urethra and halt the flow of urine. If the muscle weakening is minor, you'll probably dribble a bit. Should the weakening continue and urinary control become more difficult and less successful, you may be on your way to developing a form of incontinence (see page 270). "If the cause is weak muscles, dribbling is sort of an intermediary step between full control and incontinence," according to Richard J. Macchia, M.D., professor and chairman of the Department of Urology at the State University of New York Health Science Center at Brooklyn.
Aging is a prime cause of muscular weakening for both men and women, but giving birth and going through menopause increase the likelihood of women losing some control over their pelvic muscles. Men have a slight advantage in this regard thanks to their prostates. The gland, which surrounds the urethra below the bladder like a doughnut, grows as a man ages, Dr. Macchia explains. If the enlargement is otherwise benign and not great enough to cause a significant obstruction, the prostate squeezes on the urethra only lightly, compensating for any loss in pelvic muscle tone that could lead to leaking.
But before women start to develop prostate envy, they—and all the men—should know that an inflammation of the gland, called prostatitis, can produce a discharge that could be mistaken for dribbling, Dr. Macchia says. It'll also cause a burning sensation upon urination and a frequent need to go to the bathroom. The bacterial infection that results in prostatitis can hit men at any age, but younger men are especially prone to the problem.
Besides the pelvic weakening associated with giving birth and advancing through menopause, women have an additional concern that can lead to dribbling. Sometimes a small pocket, called a diverticulum, forms on the walls of the female urethra. This pocket can collect some urine that later drips out, Dr. Macchia says. The diverticulum often remains completely harmless. But if the dribbling becomes excessive or if the pocket enlarges, breaks or becomes infected, he says, the diverticulum may have to be surgically removed.
Ending wet spots could be as simple as learning better bathroom form or strengthening the muscles in your pelvis, say urologists. Try these tips before seeing your doctor.
Nudge out what's left. "Men should learn to milk their urethra," says Dr. Pranikoff. First, urinate through your fly, not over the top of your pants or that constrictive elastic band around the top of your shorts. When finished, with one hand apply some gentle pressure behind the scrotum to coax out any remaining urine from the bulbus urethra.
Sit back, sit wide. For women, urinating with your legs wide apart helps prevent any urine from pooling in the vagina or the urethra. Leaning forward also helps, Dr. Pranikoff says.
Give it a squeeze. Kegel exercises can help you strengthen the muscles in the pelvis and gain better control, even if you do have an enlarged prostate. And they're simple to do. The muscles you want to strengthen are the ones you use to start and stop the flow of urine. Squeeze and slowly release those muscles several times. Urologists recommend that you practice this action until you can contract those muscles 50 times in a row several times a day. (For more on Kegels, see Incontinence on page 270.)
See also Incontinence