Prostate Surgery

Terminal Dribbling: What Can I Do About Urinary Dribbling?

Various problems affect the male urinary tract, and terminal dribbling is one of them.

Since there isn’t much reliable info about this problem online, you’ll learn all about it in this post. Read on to see what terminal dribbling is, why it happens, and how to treat it. 

What is the terminal dribbling?

Terminal dribbling is a lower urinary tract symptom wherein the flow of urine doesn’t end quickly. Instead, the flow dribbles slowly towards the end.

It’s important to distinguish terminal dribble from post-micturition dribble (post-urination) dribble, which happens after voiding has been completed. Therefore, the official definition of terminal dribble states it’s a symptom when a patient experiences a prolonged final part of micturition when the flow has slowed to a trickle or dribble. 

Men with or without benign prostatic hyperplasia (BPH), prostatic hyperplasia, or an enlarged prostate can experience terminal dribbling. Although a common problem, it hasn’t been widely studied.

The reason for insufficient studies of terminal dribbling was the lack of a clear definition. For many years, this problem was often mistaken for post-void dribbling. In fact, until not a long time ago, terminal dribbling was considered the initial or mild phase of post-void dribbling.

Studies show the prevalence of terminal dribbling is high. Figures go from 91% to 96% in patients with BPH and from 73% to 79% in the community. Also, 86% of male patients with lower urinary tract symptoms (LUTS) had terminal dribbling. What’s more, terminal dribble was the second most common symptom in men with LUTS.

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Other causes of urine leakage

Before we go on, it’s important to mention other problems that cause urine leakage and voiding dysfunction, besides terminal dribbling. This includes:

  • Urge incontinence – also known as overactive bladder, the most common type of urine leakage in men. Urinary incontinence is when you have a sudden urge to urinate but can’t hold it in until you reach the toilet.

  • Stress incontinence – happens when you have urine leakage when coughing, sneezing, laughing, lifting heavy objects. This problem is common in men who have undergone prostate surgery.

  • After dribble – also known as post-void dribbling we mentioned above. When a few drops of urine leak after you’ve been to the toilet, it means you have post-void dribble. The common cause of this problem is BPH or weakened pelvic floor muscles.

  • Overflow incontinence – occurs when the bladder has pressure put on it, and the urine is forced out. In most cases, BPH is the main cause. Men with an enlarged prostate often complain their urine stream is weak, and they experience problems when trying to empty the bladder. One of these problems is the terminal dribbling. 

What causes terminal dribbling in men?

The most common cause of terminal dribble in men is bladder outlet obstruction. In this condition, terminal dribble is present with other symptoms.

Bladder outlet obstruction (BOO) in men is a blockage that slows or stops urine flow out of the bladder. This condition can cause urine to back up in the system, thus leading to difficulty urinating and other uncomfortable symptoms. Older men are more likely to have BOO than younger males. 

Possible causes of BOO

  • Bladder stones – hard masses of minerals in the bladder. They develop when the minerals in concentrated urine crystallize and form stones.

  • Certain medications such as antihistamines, decongestants, and drugs that treat overactive bladder 

  • Enlarged prostate – the most common cause of BOO in men. It is a benign enlargement of a prostate gland that blocks the flow of urine through the urethra. The exact cause of BPH is unknown, but several factors could play a role, including aging, family history, diabetes, heart disease, obesity, and a sedentary lifestyle.

  • Prostate cancer – one of the most common types of cancer in men. Number show one in nine men will be diagnosed with prostate cancer in his lifetime.

  • Scarring of the urethra (urinary channel), i.e., urethral stricture or bladder neck due to surgery or injury

  • Tumors in the rectum

Terminal dribble seldom occurs by itself. Other symptoms accompany it. That’s because terminal dribble isn’t a standalone condition or a disease. It’s one of many symptoms that men with BOO or BPH can experience in the urinary system. If BOO is the cause, besides terminal dribbling, you may also experience the following.

Symptoms of BOO

  • Pain when passing urine

  • Trouble starting a urine stream

  • Sensation like the bladder is full but unable to empty it completely. 

  • Feeling like some urine remains in the bladder after voiding, i.e., urinary retention.

  • Frequent urination, especially at night (nocturia).

  • Abdominal pain

Weak pelvic floor muscle, bladder outlet obstruction, prostate enlargement are the most significant causes of the terminal dribble. Generally speaking, any obstruction in urine flow can induce dribble-related problems.

Prostatitis may also contribute to this problem. Prostatitis is an inflammation of the prostate. It causes various symptoms, including difficulty urinating, painful urination, pain in the groin area, among others.

How can terminal dribbling be treated?

The treatment of terminal dribble depends on its cause. If you experience this problem and it isn’t going away, you need to see the doctor.

Your healthcare provider will carry out a few tests to determine the cause of terminal dribbling. Of course, if you’re already diagnosed with some urinary condition, then they may adjust the current treatment. 

Most comment tests for diagnosis

  • Rectal exam to check for the prostatic enlargement

  • Urine test to check for urinary tract infection and other conditions that may lead to terminal dribbling

  • A blood test to check for kidney problems

  • Prostate-specific antigen (PSA) test where high levels of PSA indicate enlargement of the prostate 

  • Ultrasound of kidneys may also help check the function of kidneys in cases there’s some blockage that causes urinary problems.

  • X-ray to look for narrowing of the urethra 

  • Transrectal ultrasonography (TRUS)

Once the cause of terminal dribbling is identified, the doctor recommends adequate treatment to manage voiding symptoms. The treatment of urinary symptoms depends on the severity of the condition. That’s why your doctor may also take intravesical prostatic protrusion (IPP) into consideration.

The term IPP refers to the extent to which the prostate protrudes into the bladder. The intravesical prostatic protrusion is an independent risk factor for BOO.

Every man is different. The severity of terminal dribbling and the underlying condition varies from one man to another. Treatment may vary from one patient to another as well. It all comes down to the intensity of the symptom and the problem that caused it. In men with BPH, prostate volume plays a role in the course of the treatment.

However, in most cases, the primary treatment route is the insertion of a catheter through the urethra into the bladder. The placement of the catheter alleviates the blockage and encourages a normal urine stream without trickle. 

In some instances, the healthcare professional may need to insert the tube through the stomach area to the urethra. The tube, a suprapubic catheter, drains the bladder. 

Medications

If terminal dribbling occurs due to BPH, the first line of treatment is through medications. Medications usually treat mild to moderate symptoms.

  • 5-alpha reductase inhibitors – to shrink the prostate by preventing hormonal changes that encourage prostate growth

  • Alpha-blockers – to relax bladder neck muscles and muscle fibers in the prostate to make urination easier

  • Combination drug therapy – a doctor may recommend taking 5-alpha reductase inhibitor and alpha-blockers at the same time if they aren’t effective individually 

  • Tadalafil – although its main purpose is to treat erectile dysfunction, this drug can also help with BPH

However, it is important to be aware that these medications come with side effects. Before taking any drug, be sure to do your research. In cases when terminal dribbling, and other symptoms, don’t resolve with treatment of the underlying condition, you may need surgery.

How to reduce terminal dribble?

Terminal dribble can be a frustrating problem for most men. Difficulty to empty the bladder due to trickle has a negative impact on your quality of life. It seems like the problem will never go away, right? Fortunately, terminal dribble is manageable. 

A proactive approach is important for the management of this issue. Keep in mind that terminal dribbling is a symptom of an underlying problem. It comes together with other obstructive symptoms in many cases.

So, management of the underlying condition such as benign prostate hyperplasia or BOO is important. Strive to adhere to the doctor-recommended treatment. As you manage the cause of terminal dribble, the severity of this symptom is likely to decrease.

Besides doctor-recommended treatment, you may also want to push the urethra strongly during urination. Strong, but not too hard to cause pain! This action could help you speed up the urination and avoid dribbling. 

Also, pelvic floor exercise can help you out. They improve bladder control and resolve leakage or improve urine flow. These benefits come with consistency. You need to do pelvic floor exercises, i.e., Kegels for men, regularly. At first, it may be difficult to perform Kegels. Most men believe these exercises are for women only. However, you can do them easily. To perform pelvic floor muscle exercise, you need to identify pelvic floor muscles. 

Those are the muscles that you use to stop urination midstream. Try practicing next time you go to the bathroom. When urinating, engage pelvic floor muscles to stop urination. That’s how you’ll know what to engage when performing the exercises.

Once you learn, the rest is easy. The easiest way to do these exercises is to clench or contract pelvic floor muscles, hold for a few seconds, release, and repeat. You may want to start with five seconds first. When it becomes easy, increase to six, seven, and so on.

Successful management of storage symptoms, terminal dribble, and underlying conditions require regular checkups at the doctor’s office. Try not to skip them. Your doctor can carry out various tests to ensure there’s progress.

Tips for managing terminal dribbling in daily life

As much as terminal dribbling is uncomfortable, you can make it more tolerable. Let’s take a look at simple things to do to manage terminal dribble. 

Regular exercise

A sedentary lifestyle is a major threat to your health and wellbeing. Being sedentary often goes hand in hand with weight gain. Overweight and obesity are risk factors for obstructive symptoms and other problems affecting the prostate and urinary tract of men. Therefore, one of the most important things to do to feel better is to exercise regularly.

Studies about the effect of exercise on urine flow in men revolve around BPH symptoms. They show physical activity can decrease nocturia, i.e., urgent need to urinate at night. More studies on this subject are necessary. This is especially the case with terminal dribbling and exercise. But, if you have BPH or BOO, exercise can aid their management and thereby improve terminal dribble. 

Meditation 

Meditation has many benefits. The most important effect of meditation is stress relief. Stress is a natural response of the body to any kind of threat or negative stimuli.

We can’t avoid stress entirely, but we can manage it. When left unmanaged, stress can harm our health. Stress can contribute to urinary leakage. Meditation can help you overcome this problem. Strive to meditate a few minutes every day. Focus on your breathing and allow yourself to relax. 

Avoid caffeine and alcohol

Both caffeine and alcohol can irritate the bladder. They can also increase the production of urine. As a result, you go to the bathroom more often and deal with terminal dribbling. Try to stay away from them, particularly at night.

Maintain weight in a healthy range

Excess weight increases the risk or worsens urinary problems. An important part of terminal dribbling management is to slim down or maintain weight in a healthy range.

Avoid unhealthy methods, though. The key to successful weight loss lies in a combination of a healthy diet and regular exercise. 

Tips to keep your bladder healthy

Management of terminal dribbling calls for a healthy lifestyle. You need to keep your bladder and other parts of the urinary system healthy or strive to improve their function. These tips can help you out:

  • Drink enough water – problems with the urinary flow shouldn’t stop you from drinking enough water. At least half of the fluid intake should be water; strive to avoid store-bought fruit juices and other sugar-laden beverages.

  • Quit smoking – Smoking can irritate your bladders like caffeine and alcohol.

  • Consume high-fiber foods to avoid constipation

  • Use the bathroom often and when needed

  • Be in a relaxed position when urinating

  • Wear cotton underwear

  • Don’t hold it in just because your terminal dribbling annoys you

  • Don’t use the muscles to force urine out

  • Use dietary supplements that support the urinary tract, but consult the doctor before you do so

  • Keep warm during winter because cold temperatures can cause urinary retention and increase the urgency to urinate

  • Enrich your diet with zinc, selenium, Omega-3 fatty acids, and vitamin C

Conclusion

Terminal dribbling is not a disease; it’s a symptom of an underlying problem affecting the bladder or prostate. Other symptoms co-occur with terminal dribbling.

Don’t ignore the dribble; see your doctor. Follow doctor-recommended treatment and make healthy lifestyle adjustments. With a proactive attitude, you’ll be able to manage terminal dribbling and improve your quality of life.

Sources

  1. Abrams P, Cardozo L, Fall M, et al. (2003). The standardization of terminology in lower urinary tract function: a report from the standardization sub-committee of the International Continence Society. Urology, 61(1):37-49. https://doi.org/10.1016/S0090-4295(02)02243-4
  2. Kim, J. H., Shim, J. S., Choi, H., Moon, d., Lee, J. G., Kim, J. J., Bae, J. H., & Park, J. Y. (2015). Terminal dribbling in male patients with lower urinary tract symptoms: relationship with International Prostate Symptom Score and with intravesical prostatic protrusion. BMC urology15, 89. https://doi.org/10.1186/s12894-015-0082-x
  3. Reynard, J. M., Lim, C., Peters, T. J., & Abrams, P. (1996). The significance of terminal dribbling in men with lower urinary tract symptoms. British journal of urology77(5), 705–710. https://doi.org/10.1046/j.1464-410x.1996.95615.x
  4. Benign prostatic hyperplasia (BPH). Mayo Clinic https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
  5. Key statistics for prostate cancer. American Cancer Society https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html#:~:text=About%201%20man%20in%209,at%20diagnosis%20is%20about%2066.
  6. Zheng, J., Pan, J., Qin, Y., Huang, J., Luo, Y., Gao, X., & Zhou, X. (2015). Role for intravesical prostatic protrusion in lower urinary tract symptom: a fluid structural interaction analysis study. BMC urology15, 86. https://doi.org/10.1186/s12894-015-0081-y
  7. Wolin, K. Y., Grubb, R. L., 3rd, Pakpahan, R., Ragard, L., Mabie, J., Andriole, G. L., & Sutcliffe, S. (2015). Physical activity and benign prostatic hyperplasia-related outcomes and nocturia. Medicine and science in sports and exercise47(3), 581–592. https://doi.org/10.1249/MSS.0000000000000444

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