Female post-micturition dribbling

Specialty: Nephrology and urology.

• female terminal drip
• loss of urine after urination in women

Why it occurs

• Urethral diverticulum in women (focal dilation of the ventral wall of the female urethra that acts as a reservoir for urine during urination, which is slowly emptied when standing or walking after completing urination)
• Cystocele or prolapse of the anterior vaginal wall (the anatomical distortion of the bladder neck and urethra favors the retention of small volumes in a prolapsed vaginal recess)
• Vaginal micturition entrapment (incomplete urinary emptying with accumulation of urine in the posterior vagina due to urination in the thigh adduction position or on an inadequate toilet, dripping when standing)
• Pelvic floor dysfunction or hypotonia of the perineal muscles
• Previous pelvic reconstructive surgery (which alters the urethrovesical angle)

Initial workup

Comprehensive gynecological examination with bidigital palpation of the anterior vaginal wall, pressing on the urethral tract to try to squeeze out purulent secretion or mucus; high-frequency transvaginal ultrasound or high-resolution pelvic MRI (study of choice to characterize urethral diverticula); flowmetry with measurement of postvoid residual.

Standard management

• Topical vaginal estrogens in cream — to improve the elasticity, tone and vascularization of the vaginal and peripheral urethral tissue
• Pelvic floor re-education exercises — obstetric physiotherapy to strengthen urethral support) associated with behavioral changes (such as learning to urinate with legs wide apart, leaning slightly forward to avoid urinary reflux towards the posterior vagina, and performing retrograde digital compression on the anterior vaginal wall after voiding
• Vaginal urethral diverticulectomy surgery if symptomatic and refractory to physical measures.