Overflow incontinence

Overflow Incontinence: Definition, Causes, and Treatments

Overflow incontinence is an issue affecting men and women worldwide. Numbers afflicted are estimated to be 3 to 6 million in the UK alone. Incontinence causes embarrassment and shame among people who suffer from it.

Embarrassment may lead to isolation and depression, and even to a change in relationships with others. Women are twice as likely to suffer from incontinence as men are. Both sexes may find it difficult to discuss the issue with their doctors. However, with a physician’s help, effective treatment for the condition may be available. The following article discusses one particular type of incontinence, overflow incontinence, and how it is diagnosed and treated.

Causes of Overflow Incontinence

Overflow incontinence occurs when the bladder becomes stretched beyond its normal capacity. It results in leakage of urine that can occur both day and night.

There are two underlying causes of this type of incontinence. The first is some type of blockage and the second is weak bladder contraction, which may be caused by nerve damage or weakness of the muscles of the bladder. In both cases, the result is the same: the bladder becomes overfilled to the point where urine dribbles out under pressure.

In men, an enlarged prostate gland can cause overflow incontinence when the prostate blocks the opening from the bladder into the urethra. Sometimes a stricture (narrowing) of the urethra or the bladder neck can occur, usually after surgery or radiation for prostate cancer, causing incontinence.

Stones of the urinary tract at any level may cause incontinence in both men and women.

Constipation can also cause incontinence if stool in the rectum puts pressure on the urethra and bladder neck. Diabetes can cause nerve damage that may affect the bladder’s ability to contract and empty the bladder properly.

Some medications, such as narcotics and anticholinergics, can (in effect) paralyze the bladder. Any disease or condition that affects the nerves may affect the nerves innervating the bladder and cause incontinence. An example of this would be Multiple Sclerosis.

Diagnosis of Overflow Incontinence

Diagnosing incontinence should begin with a visit to the family doctor. It may be helpful for patients to keep a diary for a week prior to their doctor’s appointment that includes daily intake of fluids and a record of how often and under what circumstances the patient was incontinent.

The physician will ask about the patient’s history, including any medications the patient is taking and any surgeries or illnesses the patient has had. A urine sample may be taken, and possibly some blood as well. The physician will examine the patient, which may include examination of the genitalia to detect any visible abnormalities. In women, the doctor may insert a gloved finger into the vagina and ask the patient to squeeze as if closing the vagina. This will help to determine tone of the pelvic floor muscles. The physician may also test for sensation in the perineum by asking the patient if they are able to feel normal touch. In men, the physician will likely examine the prostate gland by inserting a gloved finger into the patient’s rectum. This allows the physician to assess size and contour of the prostate gland. In addition to the physical exam, the doctor may ask questions regarding the nature of the overflow incontinence, such as:

• How long has the patient been experiencing incontinence?
• How often is the patient incontinent?
• Does incontinence occur at night, as well as during the day?
• Is the patient able to make it to the bathroom in time?
• Is there any discomfort associated with the incontinence, such as bladder spasm?
• How much fluid does the patient consume in a day?
• How has the patient been coping with the incontinence?

Answers to these questions, along with the physical exam, will help the physician determine the type and severity of the incontinence, and help to decide what tests or treatments should be tried to help cure the incontinence.

Treatment Options for Overflow Incontinence

Treatment of overflow incontinence depends on the underlying cause of the incontinence. For example, if medications are the culprit, discontinuing the medication or changing it may help with the incontinence. If constipation is adding to the problem, establishing a better bowel routine may help.

In addition to attempting to address the underlying issue, the patient may find some of the following self-help treatments useful:

• Decreasing fluid intake, if excessive fluid intake is an issue
• Losing weight, if the patient is overweight
• Eliminating caffeine, as caffeine is a known bladder irritant
• Bladder training, which involves voiding at regular intervals and slowly increasing the time between voids
• Kegel exercises, performed by tightening the muscles that stop and start urine flow
• Medications may be helpful. Most medications prescribed for incontinence target the bladder, and help to relax the bladder and prevent spasms of the bladder. Medications for men may be used to prevent further enlargement of the prostate if this is an issue.
• Surgical intervention may be recommended when other treatments fail. In women, surgical treatments include methods to provide support to the bladder and urethra, such as creation of a bladder sling or injection of a bulking agent into the tissue surrounding the urethra to provide support and prevent leakage of urine. In men, surgical treatments usually involve the prostate, and may include reducing its size or removing it altogether.

Incontinence should not be viewed as inevitable, and patients should be aware that in many cases incontinence can be controlled, if not cured. Patients who suffer from incontinence should seek help from their primary care physicians. Diagnosing incontinence involves a physical exam, which may include urinalysis and blood work. The patient should expect to answer detailed questions regarding the nature of the incontinence. It may be helpful if patients keep a diary of their activity and episodes of incontinence for at least a week prior to their visit to the doctor. Self-help remedies may help a number of patients. Medication may be offered in some cases. If the overflow incontinence is severe and greatly impacts the patient’s life, surgical intervention may be necessary.

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