Overflow Incontinence

What is overflow incontinence?

Overflow incontinence is a problem that causes a loss of bladder control. When you have overflow incontinence, your bladder is always full and small amounts of urine keep leaking.

How does it occur?

Overflow incontinence is most often caused by chronic urinary retention, which is an inability to empty the bladder. With chronic urinary retention, you may be able to urinate, but you have trouble starting a stream of urine or emptying your bladder completely. You may urinate often; you may feel an urgent need to urinate but have little success when you get to the toilet; or you may feel you still have to go after you have finished urinating.

Chronic urinary retention is more common in men. It is caused by enlargement of the prostate gland. The prostate is part of a man's reproductive system. It is normally, on average, a little bigger than a walnut. It is located between the base of the bladder and the beginning of the penis. It surrounds the upper part of the urethra. The urethra carries urine from the bladder out through the penis.

As many men get older, their prostate gets bigger and squeezes the urethra. This makes it harder to urinate. As obstruction from the enlarging prostate gland increases, the bladder may become overactive, causing frequent urges to urinate. As the obstruction continues, the bladder muscles get tired and weaken and eventually stop working well, resulting in retention of urine. The bladder may become infected. As time goes on, the bladder gets full all the time and the overflow urine dribbles constantly. Enlargement of the prostate gland occurs in 5 out of 10 men over age 60 and in 8 out of 10 who are over 80.

Other problems that block the urethra, such as tumors or bladder stones, can also cause overflow incontinence.

Men or women may have overflow incontinence caused by problems that affect the nerves, such as diabetes, multiple sclerosis, or spinal cord or brain injuries. Some medicines can cause or increase overflow incontinence. For example, nonprescription medicines for colds, flu, or allergy symptoms can make urination more difficult if the medicines are taken for a long time.

What are the symptoms?

At first, it may be hard to start urinating and the urine may flow in a weak stream. You may have a frequent and urgent need to urinate.

Other symptoms include:

• a need to get up during the night to urinate
• a burning pain with urination, if infection occurs
• a feeling of incomplete emptying of the bladder
• constant leaking of urine from a full bladder
• a smell of urine on your clothes and in the house.

You may keep having urinary tract infections.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. The exam will include a rectal exam because enlargement of the prostate gland can be felt through the rectum. Samples of your blood and urine will be tested. You may be referred to a urologist for further investigation and treatment. (A urologist is a doctor who specializes in disorders of the urinary tract in both men and women and in the reproductive tract of men.)

How is it treated?

Treatment of overflow incontinence is mainly drainage of the bladder and treatment of the cause. If an enlarged prostate gland is causing it, medicines may be used to shrink the prostate or to relax the muscles. This may be enough to relieve the problem. The obstruction can also be relieved with surgery.

Here are some other possible treatments:

• A collecting device fitted over a man’s penis to hold urine.
• Incontinence pads and undergarments to help catch urine leaks and protect your clothing.
• A catheter inserted into the bladder so that it can be mechanically drained on schedule.

How can I take care of myself?

• Follow your healthcare provider's advice for correcting or managing your incontinence.
• If you use a special condom and collecting bag, follow your instructions carefully.
• If you use incontinence pads for protection, change them regularly.
• Keep the groin area clean and as dry as possible.
• Find ways to stay within easy reach of a bathroom. Empty your bladder every 2 to 4 hours and before going to bed. Have a night-light and grab bars in your bathroom to help prevent falls when you are in a hurry. Be willing to ask where the toilet is when you are away from home.
• Drink plenty of fluids. Don't try to control urinary incontinence by cutting back on fluids. It won't help and may even be harmful to you.
• Avoid nonprescription medicines that relieve the symptoms of colds, flu, or allergies.