Overflow Incontinence: All You Need to Know

Introduction

Conditions affecting how a person holds or releases urine are called bladder control problems. A person with bladder control issues may not be able to hold urine for longer durations and may leak accidentally. At times, they may leak urine even before they have the urge to pass urine. When a person leaks urine accidentally, it is called urinary incontinence. Overflow incontinence is a type of urinary incontinence. This article delves into the details of overflow incontinence.

What Is Overflow Incontinence?

Overflow incontinence is a condition where one cannot empty their bladder. A person with overflow incontinence may leak urine, even when they do not have to urge it. This is the difference between overflow incontinence and other types of urinary incontinence. In overflow incontinence, leakage occurs because the bladder can not hold so much urine, as it was not completely emptied during the last voiding. On the other hand, other types of urinary incontinence occur because the bladder may not be able to control the urge to urinate.

What Are the Differences Between Overflow Incontinence and Urinary Incontinence?

When the bladder releases urine because it becomes too full, it is overflow incontinence. It occurs because the bladder is not emptying itself. Hence, the bladder gets filled fast due to the residual urine in the bladder. Overflow incontinence makes up about five percent of urinary incontinence cases. Urinary incontinence is more common among women, while the latter is more prevalent among men.

What Are the Symptoms of Overflow Incontinence?

The symptoms of overflow incontinence can include:

• A constant dripping of urine.

• Frequent urination with very little urine being released.

• Sudden release of urine without the urge to urinate.

• A weak stream of urine.

• Difficulty in starting the urine stream.

• A feeling of fullness despite passing urine.

• Frequent episodes of urinary tract infections.

• Nocturia (frequent need to urinate at night).

What Are the Causes of Overflow Incontinence?

Overflow incontinence is more common among men than in women, unlike other types of urinary incontinence. It is most common among men who have an enlarged prostate. The other causes of overflow incontinence can include:

• Blocks in the Urethra: A urethra is a tube that removes the urine stored in the bladder outside the body. Blocks in the urethra, like a tumor, urinary stones, any form of scar tissue, swelling due to some infections, etc can cause a block in the urethra.

• Weak Muscles: Weak bladder muscles.

• Nerve Injury: An injury to the nerves that control the bladder.

• Medical Conditions: Conditions like diabetes, alcoholism, Parkinson's disease, multiple sclerosis, spinal problems or back surgery, or spina bifida can affect the nerves that control the bladder.

• Medications: Medications like anticonvulsants and antidepressants can affect the nerve signals to the bladder.

• Prior Surgeries: A pelvic surgery in the past.

• Bladder Prolapse: Prolapse of the bladder or uterus in women

How Is Overflow Incontinence Diagnosed?

A detailed case history will help the doctor diagnose the condition easily. A healthcare professional may advise managing a journal to record the bladder symptoms. This can help to find out the exact cause of the incontinence. The amount of water or other fluid drank, how many times urinated, the amount of urine passed, the number of times urine was leaked, if there was an urge to urinate, etc. can be some of the information to be recorded in the journal. Some of the tests that can help to diagnose the condition include:

• Couch Test: The patient will be asked to cough to check if they leak urine while coughing. This is also called a stress test.

• Pad Test: The patient is asked to wear a pad for a certain period. This helps to know the presence and severity of the condition.

• Urine Test: This helps to know if there are any signs of infection or blood in the urine. The underlying conditions can be treated appropriately to improve overflow incontinence.

• Prostate Examination: The prostate is examined for any swellings or enlargements. This could be another reason for overflow incontinence.

• Urodynamic Testing: Urodynamic testing helps to understand the capacity of the bladder, how much urine it can hold, if the bladder can be emptied, etc. A voiding cystogram is a test done for this.

• Post-void Residual Measurement: This test helps to measure how much urine is left in the bladder after urinating. If a large amount of urine is left in the bladder, it can denote some block in the urinary tract. It can also be due to some problem in the bladder muscle or the nerves controlling the bladder.

• Ultrasound of the Abdomen: The bladder, kidneys, and other organs are examined to check for abnormalities that can cause an overflow incontinence.

• Cystoscopy: It helps to visualize the urinary tract for any abnormalities.

How Is Overflow Incontinence Treated?

The treatment of the condition depends on the cause and severity of the condition.

• Behavioral therapy: Behavioral therapy teaches the patient some methods to manage or avoid leaks.

  • Fluid Intake Management: Managing the fluid intake helps to get control of the bladder. It also includes avoiding or limiting the intake of caffeinated beverages, alcohol, and other drinks that worsen the condition. It reduces urine output and increases the risk of urine leakage.

  • Bladder Training: In this method, the patient is trained to wait a few moments after urinating. They are gradually trained to increase the duration without leakage. The bladder is trained to hold urine without leaks for a longer duration.

  • Scheduling Toilet Visits: Visit to the washroom at regular intervals reduces the risk of overflow incontinence, and prevents any leaks.

  • Double Voiding: In this method, the patient waits a few minutes after urination to empty the bladder completely.

  • Pelvic Floor Exercises: They help to strengthen the pelvic floor muscles, giving better control over urination. As the muscles get stronger, leaks are stopped. These exercises strengthen the muscles that help to start and stop urination.

• Medication: Some medicines help the bladder muscles to empty, preventing leaks. Alpha-adrenergic drugs are examples of this. However, the use of medication must be with a prescription from a qualified healthcare professional, as it can have other adverse effects, especially in women.

• Catheterization: A catheter is inserted into the urethra to help complete urine drainage from the bladder. Self-catheterization is a process where the patient does this. In indwelling catheterization, the catheter is permanently connected to the bladder, which helps empty the bladder. The urine is collected in a urine bag outside the body.

• Nerve Stimulation: Electric impulses are sent to the bladder muscles to strengthen them in this method. Percutaneous tibial and sacral nerve stimulation are the two commonly used methods. It stimulates the tibial and sacral nerves to stimulate the bladder.

• Surgery: This is generally done in severe cases where all the other methods do not give the desired results. Another case where this remains the sole method is where there is a significant swelling in the urinary tract, which hinders urine flow.

Conclusion

Overflow incontinence is when the patient cannot empty their bladder, resulting in urine leakage. It can be due to many reasons. Understanding the reason and treating it appropriately helps to manage the condition. Bladder training and double voiding can help prevent the condition from recurring. Pelvic floor exercises can also help in strengthening the pelvic floor muscles.