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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > Shy bladder or prostate swelling?
Expert: Arthur Goldstein, M.D.
Date: 10/6/2008
Subject: Shy bladder or prostate swelling?
Question
Hi I'm 35 year old male, very seldom Claritin user and live in USA.
A month ago, while under a lot of work stress, I started to notice that I wasn't able to finish my normal flow in the public restroom. I have trouble peeing in front of others to begin with. My normal flow has always been, as long as I can remember, an initial stream that has nice flow of about 90-95% empty and then another squirt or two to completely empty. Since this happened to me in the restroom (that I didn't do my normal empty squirt) it has now continued to happen to me at home. So now I hardly ever get a final squirt and am concerned that this small residual amount will cause harm (i.e. infection, incontinence). It also feels like there is a little left and slight dripping after, but this could be in my head as I have OCD and am worried a lot about this.
I was in a car accident about 20 years ago so probably had a catheter put in, and about 5 years ago they said I had pseudomonas bacteria in my urine so I took some CIPRO and had a Retrograde urethrogram. No bleeding so probably no scaring. I also once had a q-tip partially inserted into my penis to check for STDs, all negative. But like I said my initial flow is powerful most of the time so don't think it is stricture, right?
I work at a computer all day. And around the same time this started I have been cutting back on beer and caffeine.
So I'm wondering if it is normal to just have one stream with a bit of dripping after words, specially as I age?
Answer
Keith, difficulty voiding in public places is very common and affects about 7% of people. Medically this is termed "paruresis". In fact, there is an international and several local associations that are support groups for individuals so afflicted. The following link will give you more in depth information about parureisis.
http://www.paruresis.org/
Post voiding dribbling is a very common problem. It is due to trapping of some urine in the urethra which then leaks out after one has finished urinating. Minor leakage is common in most men. It is usually due to an obstruction such as from a swollen prostate, a narrowing of the urethra (stricture) or a narrowing at the penile opening (meatus). The most common causes are from a swollen prostate (either an inflammation, so called prostatitis or a benign enlargement of the prostate - BPH). In my experience, another frequent cause is in those men who remove their penis through the unzippered fly, void and then put the penis back. Often, the space is not adequate for total free flow as the lower (bottom) edge of the fly can actually push on the urethra causing urine to be trapped. This phenomenon can be totally avoided by dropping your trousers and then urinating in the standing or sitting position. Try the latter and if you are cured, no further evaluation is necessary. If the dribbling persists but is mild, get in the habit of "stripping" or milking the urethra from just behind the scrotum forward a couple times after voiding and then pat dry. If the problem persists or is more severe, you need to see a urologist in consultation. Good luck!
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