BPH

Overflow Incontinence: Symptoms, Causes, and Treatments

Urinary incontinence is defined as the unintentional passing of urine. Men and women alike can have this problem. Incontinence harms a person’s quality of life.

It’s not uncommon for patients to feel uncomfortable spending time with other people. Although incontinence is common, there is a lot we need to learn about it.

The main subject of this post is overflow incontinence. What is overflow incontinence? How to recognize it? Why we have it? Is it possible to treat it? You’ll find all the answers below.

What is overflow incontinence?

Overflow incontinence (OFI) is a urinary incontinence type wherein a person doesn’t feel the urinary urgency, although the bladder is overly full and releases urine involuntarily. The exact prevalence of overflow incontinence is unknown. However, urinary incontinence is a major problem in general. 

A quarter to a third of men and women in the United States has urinary incontinence. In other words, millions of Americans have this problem. Approximately 33 million people have overactive bladder, for example. 

According to some figures, about 5% of people with chronic urinary incontinence have overflow incontinence.

What are the symptoms?

Generally speaking, urinary incontinence manifests itself as occasional, minor leaks of urine. The exact signs and symptoms may vary from one type of urinary incontinence to another. The most common symptoms of overflow incontinence include:

  • Difficulty urinating even when you’re feeling the urge to urinate

  • Dribbling

  • During urination, a urine stream stops and restarts

  • Feeling bladder fullness even after you urinate 

  • Incomplete emptying 

  • Leakage of urine while sleeping

  • Nocturia (frequent urination at night)

  • Poor or weak stream

  • A sudden release of urine

The severity of overflow incontinence symptoms isn’t necessarily correlated with the severity of the benign prostatic hyperplasia or underlying cause. Also, a presentation of lower urinary tract symptoms may occur due to other reasons. That’s why it’s essential to consult your doctor and avoid self-diagnosis. 

What causes it?

Studies confirm overflow incontinence is a condition of paradoxical incontinence caused primarily by chronic urinary retention. In this situation, the intra-vesical pressure eventually equals the urethral resistance.

As a result, you experience periodical leakage and dribbling but find it difficult (or impossible) to empty the bladder. Obstructive processes anywhere in the lower urinary tract or impaired bladder emptying disorders can lead to the development of OFI, too.

One of the leading causes of overflow incontinence is a bladder outlet obstruction secondary to benign prostatic hyperplasia (enlarged prostate) in men. Other bladder outlet obstructive disorders include:

Another common cause of overflow incontinence is decreased emptying of the bladder due to reduced bladder contractility. Impaired bladder contraction (or weak detrusor contraction) can happen due to several reasons, such as:

  • Hypotonic or neurogenic bladder states

  • Spinal cord injuries

  • Diabetes

  • Prolonged urinary obstruction

  • Side effects of certain medications 

Overflow incontinence is more common in men and women. This could explain why the most common cause of OFI is an enlarged prostate, as seen above. The prostate sits at the base of your urethra. As you’re familiar already, the urethra is a long tube that carries urine out of your body. 

Prostate enlargement puts increased pressure on the urethra. In turn, it becomes difficult for you to urinate. Your bladder may also become overactive. When that happens, a man with an enlarged bladder has the urgency to urinate quite often. Eventually, the muscles of the bladder weaken. 

The weakened muscles don’t allow you to empty the bladder entirely. So, even after you urinate, there’s still some of the urine remaining in the bladder. The bladder becomes full quickly, and urine starts leaking out. That’s why you experience overflow incontinence. 

Who is at risk?

Everyone can develop overflow incontinence, especially men. Some factors, however, increase the risk of developing this type of urinary incontinence. Any health problem that can obstruct urine flow or pressure the urethra may contribute to overflow incontinence. Some important risk factors include:

  • Medications that affect nerve signals to the bladder, such as anticonvulsants and antidepressants 

  • Nerve damage from diseases such as diabetes, Parkinson’s disease, multiple sclerosis, back problems, spina bifida

  • Alcoholism (because it can damage nerves and contribute to prostate-related problems)

  • Back surgery

  • Sustaining an injury to the nerves that affect the bladder

  • Weak bladder muscle (it is unable to support bladder contraction and empty the bladder)

  • Conditions that cause blockages to the urethra, such as urinary stone, scar tissue, swelling from infection, tumors

  • Previous pelvic surgery

How it compares to other types of incontinence

Overflow urinary incontinence is just one of several types of urinary incontinence. But, a common mistake people make is that they think all urinary incontinence cases are the same.

To truly understand OFI, it’s important to compare it to other types of this uncomfortable condition. These include stress incontinence, urge incontinence (overactive bladder), mixed urinary incontinence, reflex incontinence, and functional incontinence. Below, you can learn more about each of these types of incontinence

Stress incontinence 

Stress incontinence occurs when physical activity or movement puts pressure (stress) on the bladder, causing urine leakage. These activities and movements can be anything, including coughing, sneezing, laughing, heavy lifting, running, among others. 

This type of incontinence is more prevalent in women than in men. Stress urinary incontinence happens when the muscles and other tissues supporting the urethra as well as the urinary sphincter weaken. The urinary sphincter controls the release of urine. 

The weakening of these muscles can occur mainly due to childbirth in women and prostate surgery in men. For example, a prostatectomy is a common approach for treating prostate cancer, but it can also weaken the urethral sphincter and induce stress incontinence. 

Urge incontinence

Urge incontinence happens when you have a sudden urge to urinate, even if the bladder is not full. Some people might not even be able to make it to the bathroom in time. 

Urge incontinence is also known by other names, including overactive bladder, bladder spasm, spasmodic bladder, irritable bladder, and detrusor overactivity or instability. 

Although everyone can develop urge incontinence, women are more susceptible than men. Older adults are at a higher risk of developing this type of incontinence as well. It’s useful to bear in mind that urge incontinence isn’t a disease per se but a symptom of an underlying medical problem or an unhealthy lifestyle. 

In many cases, the exact cause of urge incontinence is unknown. But some potential causes may include bladder infection, bladder inflammation, bladder stone, enlarged prostate, obstruction of an opening of the bladder, bladder cancer, diseases of the nervous system, e.g., multiple sclerosis, and injury to the nervous system due to stroke or trauma to the spinal cord.

Mixed incontinence

Mixed incontinence happens when a person experiences symptoms of two or more types of incontinence. In most cases, people with mixed incontinence have a combination of both stress and urgency incontinence. Similar to other types of incontinence, this kind is also more common in women than men.

A combination of factors may cause mixed incontinence. Basically, the causes of both urge and stress incontinence can be behind this condition too. Men can also experience mixed incontinence, especially after prostate removal or surgery for an enlarged prostate

Reflex incontinence 

Reflex incontinence is an involuntary loss of urine due to a spasm of a bladder’s detrusor muscle. Since it involves a spasm of this particular muscle, reflex incontinence is similar to urge incontinence. The only difference is that patients with reflex incontinence don’t necessarily feel the urge to urinate.

This form of urinary incontinence is associated with neurological factors that affect messaging from the brain to your bladder. For that reason, it is categorized as spinal or supraspinal reflex incontinence. 

A lot of factors can damage nerves and prevent them from warning the brain when the bladder is full. These factors can include radiation treatment, spinal cord injuries, multiple sclerosis, and surgery. 

Functional incontinence

Functional incontinence is a type of incontinence where a person is unaware they need to urinate. Also, they may not know where to find the toilet or how to get in the ideal position to go to the bathroom. This type of incontinence happens when an issue unrelated to the urinary tract causes a person to have “accidents.”

In most cases, the cause of functional incontinence is caused by physical barriers or mental issues. These factors make it difficult for a person to go to the bathroom in time. Functional incontinence may occur due to dementia, Alzheimer’s disease, mental illness, certain medications, and physical disability. 

As you can see, overflow incontinence differs from other types of incontinence in terms of causes. Also, OFI is the only type of incontinence that is more prevalent in men than in women. Besides those mentioned above, a person can also have fecal incontinence. However, this post focuses only on cases that affect urine leakage.

Diagnosis

Incontinence is not something to ignore. If you notice symptoms from this post, make sure to schedule an appointment to see your doctor. Describe the signs in detail, even if you think they’re not important. While a doctor may suspect OFI is the culprit, they will need to diagnose the condition first. 

Your doctor may ask a few questions to which you need to respond truthfully. These questions may include:

  • What is your liquid intake? 

  • How often do you go to the bathroom?

  • How much urine do you produce?

  • Do you experience the urge to urinate?

  • When do you urinate?

  • How many leaks have you had?

  • Does leaking occur frequently?

  • Can you empty the bladder?

  • What medications are you taking?

These are just examples of questions a doctor may ask to establish patterns behind incontinence. 

Besides these questions, the healthcare professional will also perform diagnostic tests to identify the type of incontinence you have. These tests include:

  • Physical examination – to look for the signs of nerve damage that affects the bladder and rectum.

  • Bladder stress test – to see if you lose urine while coughing 

  • Catheterization – or a post-void residual urine measurement; a patient goes to the bathroom to empty the bladder. A doctor inserts a catheter to see if more urine comes out. The presence of urine in the bladder after emptying could mean you have OFI.

  • Urinalysis and urine culture – to check for urinary tract infection and other abnormalities, including kidney stones

  • Ultrasound – to visualize inner organs such as the kidneys, bladder, and ureters. It measures how much urine remains in the bladder after emptying. 

  • Prostate exam – checks for an enlarged prostate 

Treatment options

Treatment of overflow incontinence can be tricky but achievable. The exact course of the treatment depends on the severity of symptoms. Upon diagnosing the condition, the doctor will recommend a suitable approach to manage the symptoms and improve your quality of life. 

At-home behavioral training and medications could be the first recommended approaches.

Medications

Several types of medications can treat overflow incontinence. For example, the doctor may prescribe alpha-blockers. These medications relax muscle fibers in prostate and bladder neck muscles. As a result, the bladder can empty more completely. Some of the most common alpha-blockers include alfuzosin (Uroxatral), tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo), and terazosin. 

Besides alpha-blockers, 5a reductase inhibitors could also help treat OFI in men. The main objective of these drugs is to treat BPH

Keep in mind that medications for overflow incontinence are mainly prescribed for men. But women, as well as men, can benefit from other types of treatments. 

At-home behavioral training

The purpose of at-home behavioral training is to teach the bladder to control leaks. You need to wait 10 minutes to urinate after feeling an urgency to go to employ this approach. Ten minutes should be a starting point. Try to work your way up to only urinating every two to four hours. Be patient; this will work when you’re persistent and do it regularly. 

You can also give double voiding a try. In this case, you wait a few minutes after urination and try to go again. Double voiding can help you train the bladder to empty completely. 

Yet another aspect of at-home behavioral training is to schedule bathroom breaks. In a nutshell, you may try to urinate every two to four hours instead of waiting to feel an urge to go. 

Pelvic floor muscle or Kegel exercises are beneficial for men and women alike. They strengthen the pelvic floor and support bladder control. To do pelvic floor exercises, you need to tighten the muscles you use to stop urinating, hold for a few seconds, release, and repeat. Do it three times a day. Strive to do 10 reps. 

In cases when medications and at-home training don’t work, the doctor may recommend another approach – medical devices. 

Medical devices

Medical devices work to stop or catch leaks. They include:

  • Adult undergarments – similar to regular underwear, but absorb leaks. Men may need to use a drip collector. Drip collector is absorbent padding that you can place in normal underwear (but make sure it’s close-fitting)

  • Indwelling catheter – to drain the bladder. Also, your doctor will teach you all about intermittent self-catheterization 

  • Pessary and urethral insert – recommended for women. A pessary is a stiff vaginal ring a woman wears all day. It is useful for women with prolapsed uterus or bladder. The ring prevents urinary leakage. On the other hand, a urethral insert is a disposable device similar to a tampon to stop the leaks.

Surgery

Surgery is the last resort, i.e., a treatment the doctor recommends only when other approaches fail. Various surgical procedures could help manage overflow incontinence, including:

Conclusion

Overflow incontinence is the only type of incontinence that affects men primarily. The condition occurs mainly due to chronic urinary retention and enlarged prostate gland.

Other health problems can also contribute to OFI, e.g., nerve damage caused by multiple sclerosis or diabetes. Management of OFI revolves around medications and at-home bladder training, but surgery may also be an option. Don’t ignore symptoms you experience, especially if you have prostate problems. 

Sources

  1. What is urinary incontinence? Urology Care Foundation https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence
  2. Urinary incontinence. StatPearls https://www.ncbi.nlm.nih.gov/books/NBK559095/
  3. Overflow incontinence. Michigan Medicine https://www.uofmhealth.org/health-library/uh1227
  4. Demaagd, G. A., & Davenport, T. C. (2012). Management of urinary incontinence. P & T : a peer-reviewed journal for formulary management37(6), 345–361H.
  5. Badejoko, O. O., Salako, A. A., & Egharevba, P. (2014). Overflow urinary incontinence due to bladder stones. International urogynecology journal25(3), 425–427. https://doi.org/10.1007/s00192-013-2153-4

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