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Lower urinary tract symptoms in men, age-related (including symptoms of benign prostatic hyperplasia/hypertrophy) - Management
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How do I manage a man with post micturition dribble not due to urinary obstruction?
- Assess the severity of the symptoms by asking 'What protection do you need to cope with the leakage?'
- Advise the man that he can reduce the dribble by milking his urethra after urinating.
- The man should press his fingers behind the scrotum and gently massage the bulbar urethra, in a forwards and upwards motion. This technique is explained on the website of the Bowel and Bladder Foundation (see www.bladderandbowelfoundation.org), which also has other information and resources for people with bladder problems.
- Urethral milking eliminates post-micturition dribble when the muscles surrounding the urethra do not completely drain it of urine. Urethral milking is unlikely to help if the post-micturition dribble is caused by urinary obstruction.
Basis for recommendation
These recommendations are in line with the guideline The management of lower urinary tract symptoms in men from the National Institute for Health and Clinical Excellence (NICE) [NICE, 2010].
Post-void urethral milking
- When dribbling is not caused by obstruction, NICE recommends post-void urethral milking on the basis that it is a simple technique with an established safety profile, and it is a quick and easy technique to teach and learn. Clinical evidence of benefit is from one small trial with methodological weaknesses [NICE, 2010].
Providing information and advice
- NICE recommends providing men with lower urinary tract symptoms with information and advice on the basis of expert opinion, as they found no relevant clinical trials [NICE, 2010].
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