Overflow Incontinence

If you find yourself leaking urine during the day or even wetting the bed at night, you may be experiencing symptoms of overflow incontinence.

Overflow incontinence is one of several different types of incontinence, the inability to control urination. 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.

Causes of Overflow Incontinence

Unlike other types of incontinence, overflow incontinence is more common in men than women. The most common cause in men is an enlarged prostate, which impedes the flow of urine out of the bladder. Other possible causes of overflow incontinence include:

• Blockages of the urethra (the tube that carries urine from the bladder to outside the body) from tumors, urinary stones, scar tissue, swelling from infection, or kinks caused by dropping of the bladder within the abdomen
• Weak bladder muscles, which are unable to squeeze the bladder empty
• Injury of nerves that affect the bladder
• Nerve damage from diseases such as diabetes, alcoholism, Parkinson's disease, multiple sclerosis, back problems/back surgery, or spina bifida
• Medications, including some anticonvulsants and antidepressants, that affect nerve signals to the bladder

Diagnosis of Overflow Incontinence

If you have problems with incontinence, it's important to speak with your doctor. Determining the type you have and the best treatment for it will begin with describing the problem. Your doctor may ask questions such as:

• How often do you go to the bathroom?
• When you go to the bathroom, do you have trouble starting or stopping the flow of urine?
• Do you leak urine during certain activities?
• Do you leak constantly?
• Do you leak urine before you get to the bathroom?
• Do you experience pain or burning when you urinate?
• Do you get frequent urinary tract infections?
• Have you had a back injury?
• Do you have a medical condition that could interfere with bladder function?
• What medications are you taking?

Next, your doctor will perform a physical examination and look for signs of damage to the nerves that affect the bladder and rectum. Depending on the findings of the examination, your doctor may refer you to a urologist (a doctor who specializes in diseases of the urinary tract) or neurologist (a doctor who specializes in diagnosing and treating diseases of the nervous system).

Tests are often needed. These may include:

• Bladder stress test. Your doctor checks to see if you lose urine when coughing.
• Catheterization. After having you go to the bathroom and empty your bladder, the doctor inserts a catheter to see if more urine comes out. A bladder that doesn't empty completely could indicate overflow incontinence.
• Urinalysis and urine culture. Lab technicians check your urine for infection, other abnormalities, or evidence of kidney stones.
• Ultrasound. An imaging test is performed to visualize inner organs such as the bladder, kidneys, and ureters. This can also be used to measure how much urine remains in your bladder after you empty your bladder.

If the diagnosis is still not clear, your doctor may order urodynamic testing. Urodynamic testing can evaluate bladder contractions, bladder pressure, urine flow, nerve signals, and leakage.

Other tests to confirm a diagnosis may include: cystoscopy, a test that examines the inside of the bladder with a small scope called a cystoscope; a CT scan to evaluate the kidneys and bladder; and IVP, a procedure in which a special solution is injected into a vein in your arm and an X-ray is taken of your kidneys, ureters (the tubes that carry urine from the kidneys to the bladder), and bladder.

Treatments for Overflow Incontinence

Treating overflow incontinence can be difficult, but for some men with an enlarged prostate, treatment with a type of medication called an alpha- adrenergic blocker -- including doxazosin (Cardura), alfuzosin (Uroxatal), prazosin (Minipress), tamsulosin (Flomax), silodosin (Rapaflo), and terazosin (Hytrin) -- can help relax the muscle at the base of the urethra and allow urine to pass from the bladder. Timed urination every 2-3 hours can help keep the bladder empty. Waiting 30 seconds after urinating to see if you can urinate again may also help empty the bladder.

If medications do not relieve overflow incontinence, your doctor will have you use a catheter to ensure your bladder is emptied when you go to the bathroom. A catheter is a very thin tube that you can place in the urethra yourself. Your doctor or nurse can teach you how to self-catheterize. The process is simple, and single-use catheters are small enough to carry in your purse or pocket and are easy to dispose of after use.

Surgery may be needed if overflow incontinence is caused by a blockage, such as prostate enlargement.

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