What is Overflow Incontinence?
Overflow incontinence occurs when you are unable to completely empty your bladder; this leads to overflow, which leaks out unexpectedly. You may or may not sense that your bladder is full. The leakage, which can cause embarrassment and discomfort, is not the only problem. Urine left in the bladder is a breeding ground for bacteria. This can lead to repeated urinary tract infections.
How common is Overflow Incontinence?
Overflow incontinence is less common than other types of incontinence however, it is more common in men than women as it is often linked to an enlarged prostrate.
What Causes Overflow Incontinence?
Overflow incontinence, sometimes called chronic urinary retention, is usually caused by a blockage or obstruction to the bladder. The bladder will fill up as usual, but as it is obstructed it will not be possible to empty it completely. At the same time, pressure from the urine that is still in the bladder builds up behind the obstruction, causing frequent leaks.
The main reasons that the bladder can become obstructed, causing overflow incontinence are an enlarged prostate (this is very common for men), constipation or bladder stones. As these are all treatable and also symptoms of other conditions it is important you consult a doctor or health professional if you experience overflow incontinence.
Overflow incontinence may also be caused by the bladder (detrusor) muscles not fully contracting. This means that the bladder does not completely empty when you go to the toilet and this may result in the bladder becoming stretched. The detrusor muscles may not fully contract if there is damage to the nerves (for example as a result of surgery to the bowel or other conditions such as diabetes, Parkinson's Disease or Multiple Sclerosis) or a spinal cord injury, or as a side-effect of certain medications (including some anticonvulsants and antidepressants).
Diagnosing Overflow Incontinence
To diagnose an incontinence condition, your health professional should ask about your symptoms and medical history. You may be asked to keep a ‘bladder diary’ for a week or so. This should record your fluid intake (what and how much you drink) and fluid output (the amount of urine you produce, and when you pass urine), whether you had an urge to urinate and the number of times you unintentionally pass urine.
They may also carry out a test on a sample of your urine to check that your urge incontinence isn't being caused by a secondary cause such as an infection in your urinary tract and they may also do a blood test to check that your kidneys are working properly.
In some cases you may be referred to a Urologist who specialises in treating conditions of the urinary system). Alternatively, depending on the results of the examination, women may find themselves referred to a Gynaecologist (a specialist in women's reproductive health) or Urogynaecologist (a specialist in urinary and associated pelvic problems in women).
These specialists may carry out more detailed tests such as an Ultrasound (commonly used to check that your bladder is emptying properly), Cystoscopy (Looking inside the bladder and urinary system to identify abnormalities that may be causing the incontinence) or Urodynamic testing. Urodynamic testing measures the pressure in your bladder and the flow of urine. A catheter, is inserted into your bladder through your urethra and water is then passed through the catheter so the pressure on the bladder can be recorded.
How can I manage Overflow Incontinence?
Often treatment depends on the diagnosis of the underlying cause of the Overflow Incontience, e.g. if medication is causing the problem then the solution may simply be to stop the medication or change the drug used.
When the underlying cause is not known then pelvic floor exercises may help improve the condition although will not resolve it.
Whilst the problem is being investigated it is important that the bladder is emptied properly to reduce the risk of the residual urine in the bladder becoming infected as this can cause further complications.
Often this will involve using a catheter (a thin, flexible plastic tube that is passed into the bladder through the urethra) to empty the bladder. Sometimes the catheter will be left in place so that the urine can be constantly drained into a collection bag which is worn on the leg. Your doctor or specialist will advise if catheterisation is required and normally catheterisation will only be needed until the cause of obstruction has been treated.
Other treatments may include surgery (if the problem is found to be caused by a blockage such as a tumour or stone that can't be passed) or medication such as alpha-blockers. These can be effective in reducing the symptoms of overflow incontinence by relaxing the portion of the urinary tract where the bladder flows into the urethra and thereby allowing urine to flow out more easily.
No matter what type of Incontinence you or the person you care for is experiencing it is important you discuss this with a Health Professional. Incontinence is often a symptom of an underlying condition and in many cases simple steps can help improve the condition.