I was in the clinic where I was training to be a therapist. After taking my next client to the room where we would be talking, I left the room briefly to grab some notes and to urinate. After peeing and leaving the bathroom, I felt a warm sensation running down my leg. Looking down, I noticed a dark streak of urine on my light khaki pants. What am I going to do? I wondered, feeling frustrated and worried. What will my client think when I return with piss-soaked pants? When I entered the room where the client was sitting, I chose to engage in conversation as soon as I walked in and to sit down quickly and place the foot of the wet leg on the thigh of the other. I hoped that by not paying attention to the fact that I had pissed my pants, my client would not notice.
I thought I knew how to pee properly. I would empty my bladder and then shake and pull on my penis before putting it away, in the manner I imagined that you’re supposed to. I was never taught how to do this of course; I just kind of figured it out and I believed that the wiggling did something useful, perhaps removing the last drops of urine from my urethra. But in my mid-thirties, this technique stopped working. After ceasing to voluntarily pee, additional involuntary peeing would occur, especially when I sat down, crouched, or bent over.
Around this time, I happened to be on the phone with my uncle, who was in his late-seventies. We were talking about his struggles with old age when he told me that he also found himself peeing after he had thought he had finished. After he informed me that I had pee-soaked pants in my future, I revealed that I was already suffering from a similar form of incontinence. Since there were now at least two of us suffering, I set out to find a solution.
In humans, the urethra is the name of the tube that caries urine from the bladder to where it exits the body, which in males is at the distal end (the tip) of the penis. After leaving the bladder and passing through an internal sphincter, the urethra goes down through the center of the donut-shaped prostate gland, then through a second, external sphincter. The urethral home-run then involves a potential side-track into the urethral bulb, a wider section of the urethra underneath the perineum where its course changes from vertical to horizontal. The perineum, by the way, is the area between the anus and testicles. After traveling horizontally, the urethra then drops vertically down the (flacid) penis to finally reach daylight.
I wondered if the additional urine that was leaking out had collected in my urethral bulb, so I performed a little experiment: after urinating, using my index and middle finger, I massaged from the back of my perineum to the front. This action seemed to successfully milk the vestigial urine out of my urethra. Since I have developed this skill, the troubles with urine dribbles stopped. I’ve now been doing this for years.
I don’t know why this would have become an issue in my thirties. Perhaps the elasticity of the urethra reduced with age, leading to the bulb retaining a larger shape that could capture urine. Perhaps my pelvic floor was less toned than it was when I was younger, allowing the bulb to droop down below the level of the horizontal exit path.
I expect that my uncle, who is forty years older than me, may have other issues related to urination, including the common and well-documented issue of benign prostatic hyperplasia (BPH), in which the prostate gland becomes enlarged, constricting the flow of urine through its central hole. Nevertheless, I imagine that people with BPH would most likely also benefit from proper milking of the urethral bulb, so I informed my uncle of this solution.
Amazingly, even Harvard Medical School does not, apparently, teach correct urethral milking for those suffering from BPH. The technique they describe would have no effect on the post-urination dribbling caused by urine that has collected in the urethral bulb because it recommends milking the urethra starting at the base of the penis, in front of the testicles.
It’s important to be gentle when applying pressure to the sensitive perineum area because prolonged pressure or trauma to this area is associated with sexual dysfunction in men. So be gentle; very little force is needed to massage the urine out.