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Urology/Abnormal discharge of fluid, Urinary Incontinence

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QUESTION: I need your advice over some very serious concerns which I am facing for the last year and so.

The whole mess has started with the Stress Urinary Incontinence a couple of years ago. Initially it used to happen very less often. By the time the frequency has increased and now I dribble (only a few drops) on every alternate urinary attempt on average. I never paid attention, never consult with the doctor and now cursing my self for being ignorant for such a long time.

This is not all; I started experiencing discharge of some white fluid (possibly semen) while urination since last year. But this used to happen only once in a week and that too 3-4 drops only on average.

The worst part: For the last few months, I am frequently experiencing fluid discharge (possibly semen) from penile during bowel movement. Most of the time it occurs with an autonomous tweak to some inside muscles when I exert some pressure or force to pass stool as I have a constipation problem too.

I am 26 years old, un-married, never had an intercourse. I used to masturbate since puberty (14-15 years of age) once per weak on average. I sometimes hold back my ejaculation with masturbation by squeezing the penile head. I am afraid if this shit has ruined my life. Since last year after witnessing all this mess, I masturbate very less often and have almost quit masturbating for the last 3-4 months. Going to get married after 6 months and praying if everything goes fine with my forthcoming sexual life.

Current situation: (1) having stress urinary incontinence on every third urinary attempt. (2) Penile fluid discharge during bowel movements on almost every third attempt. (3) Quit masturbation completely. (4) Finally, I have started doing kegel exercise for the last 2-3 weeks and feeling some recovery signs for urinary incontinence.

I would be very grateful to you if you kindly advice me over the following:

1. Where I am standing at this point in time? What diseases and/or disorders I have fallen prey to?

2. Is it the semen which discharges from penis during bowel movements or sometimes during urination? If so, Is it dangerous? Will it affect my sexual life?

3.  Should I keep doing kegels for treating urinary incontinence?

4.  What are my options to get back to a healthy life? You’ll be definitely advising me to see an Urologist. Though, I have just taken an appointment but Would you also suggest me any other treatment/cure for the above-mentioned disorders

Many Many Thanks in Anticipation.

ANSWER: The fluid from the penis after a bowel movement is not semen; it's prostatic fluid that is expressed as the stool passes and presses on the prostate.  This is not dangerous and will not affect future fertility or sexual ability.

You may or may not actually have stress incontinence.  Since you didn't describe the exact nature and severity of the problem, I can't be sure of the type of incontinence that you actually have but in general, stress incontinence in men who have not had pelvic surgery or radiation would be very unusual.

Kegels are often recommended for stress incontinence.  Since we are not absolutely sure about the type or nature of your actual incontinence, it's impossible to predict if this is likely to help or not.

Your options to return to a healthy life are to talk to your general or family physician. If necessary, a urology consultation may be helpful.  You've indicated that you already have an appointment with a urologist and I therefore suggest that you keep it.  Meanwhile, do a 24 hour voiding diary indicating the time and the amount that you void and whether or not there was any leakage, the amount of such leakage and what you were doing at the time such as straining, lifting, coughing, etc.  This information will greatly assist your urologist in sorting out your problem.



---------- FOLLOW-UP ----------

QUESTION: Dear Sir,

Many Thanks for your earlier reply.

Even I'm unsure of the type of incontinence. Actually once I leave washroom then I feel leakages (3-4 tiny drops) with some physical movements such that my lower abdominal area gets involved or pressed by that movement. These movements include, but not limited to, sitting down, leaning towards my feet, coughing etc. This leakage seems to occur within 5 minutes once I leave washroom and that too 3-4 tiny drop only. It is worth mentioning here that It does not happen every time rather on every third urinary attempt on average.

Besides this, I usually DO NOT experience any immediate and/or frequent urge to urinate. Neither I feel any pain/inflammation/irritation/burning sensation while urinating.

I have tried to research on internet and found that my symptoms are most relevant to 'Stress Incontinence', yet I would appreciate if you kindly share your opinion regarding the same.

Further, regarding penile fluid discharge during bowel movements, I would appreciate if you name out this disease or what this symptoms are called in Medical terms. Please also advise if this can be treated easily ?

Many Thanks once again !

Answer
The way you describe the "incontinence", it sounds more like post void dribbling and not true incontinence.  The best treatment for post void dribbling is after voiding, press your fingers upwards at the base of the scrotum and then move your hand forward to the base of the penis.  This will express the teaspoon or so of fluid that tends to collect in the bulbous urethra.

Expression of prostatic fluid from a bowel movement is not a disease and therefore there are no symptoms.  If you are squeezing the prostate and expressing some fluid this is an expected consequence of the original pressure on the prostate.  There is no specific treatment since it's not abnormal.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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