Overflow Incontinence

What is overflow incontinence?

Your bladder is an organ in your urinary system that holds urine. Overflow incontinence occurs when you leak or dribble urine because your bladder is too full. Some people experience overflow incontinence because they can’t empty their bladder all the way when they pee.

How common is overflow incontinence?

As many as 1 in 3 Americans have some type of urinary incontinence that causes them to leak urine uncontrollably. Urinary incontinence, in general, more commonly affects women. But overflow incontinence tends to affect more men.

What are the types of urinary incontinence?

Overflow incontinence is a rare type of urinary incontinence. More common types of urinary incontinence include:

• Stress incontinence.
• Urge incontinence.
• Mixed incontinence (a combination of stress and urge incontinence).

What causes overflow incontinence?

Urinary retention, or a too-full bladder, causes overflow incontinence. The bladder is an essential part of your urinary system. It may fill up due to:

• Increase in urine volume due to diabetes, medicines like diuretics or other causes.
• A blockage in your bladder (such as a bladder outlet obstruction) or urethra (the tube that carries urine out of the body) that prevents the bladder from completely emptying.
• Weak bladder muscles or nerve damage.

What are the risk factors for overflow incontinence?

Men with prostate issues are most likely to develop overflow incontinence related to prostate problems. Conditions like an enlarged prostate (benign prostatic hyperplasia) or prostate cancer can block the urethra, allowing only small amounts of urine to come out when you pee. After prostate cancer surgery, radiation or other surgery on the urethra, you can develop scar tissue that causes a blockage, called a stricture. If you don’t fully empty your bladder, the half-empty bladder fills again quickly. When it gets full, you can leak urine.

People with diabetes, nerve damage and spinal cord injuries are also more prone to overflow incontinence.

What are overflow incontinence symptoms?

Signs of overflow incontinence include:

• Constant dribbling or leaking of urine.
• Frequent urination with only small amounts of urine coming out.

How is overflow incontinence diagnosed?

Your healthcare provider does a physical exam, which may include a pelvic exam or a rectal prostate exam, depending on your gender. Your healthcare provider may ask you to keep a bladder diary to track your fluid intake, bathroom use and urine leakage for two to three days.

Tests for overflow incontinence include:

• Urinalysis to look for problems like urinary tract infections (UTIs) and blood in your urine (hematuria).
• Abdominal ultrasound to examine your bladder, kidneys and other organs.
• Cystoscopy to view inside your urinary tract.
• Voiding cystogram, a scan to view your bladder as it fills up with a liquid and then empties.
• Urodynamic testing, including a postvoid residual urine test, to see how well your bladder and the rest of your urinary tract hold and release urine.

How can you manage overflow incontinence naturally?

These steps may improve overflow incontinence:

• Bladder training or timed voiding: You use the bathroom at set intervals throughout the day to prevent the bladder from getting too full, even if you don’t feel the need to go.
• Double voiding: You try to urinate again after you finish peeing. Or you may bear down when you urinate to empty your bladder fully.
• Pelvic floor exercises: Kegels, or pelvic floor exercises, strengthen the muscles that support your bladder. Your healthcare provider may use biofeedback to help you learn the correct way to do these exercises.

What are the treatments for overflow incontinence?

Treatments for overflow incontinence depend on the reason you’re not emptying your bladder and include:

• Medications to shrink an enlarged prostate.
• Surgery to remove a blockage.
• Self-catheterization (clean intermittent catheterization) to empty your bladder by inserting a catheter through your urethra and into your bladder.
• Indwelling catheterization to place a permanent catheter into your bladder that empties into a urine drainage bag outside of your body.
• Suprapubic catheter, which is a permanent catheter the goes through your lower abdominal wall directly into your bladder to avoid using your urethra.
• Nerve stimulation to send electrical pulses to nerves and strengthen bladder muscles. Types include percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation.

What are the complications of overflow incontinence?

People with overflow incontinence leak small amounts of urine, but the leaks are constant. They can result in a loss of a large volume of urine by the end of the day.

Adult diapers and absorbent urinary pads can catch these dribbles. But you may worry about an odor or how the products look under your clothes. You may become self-conscious about going out in public, leading to isolation, anxiety and depression. Constant skin exposure to urine can also lead to skin rashes and sores.

Importantly, when your bladder doesn’t empty completely to flush all the urine out, you’re at risk of developing urinary tract infections, including bladder, prostate and kidney infections. The excess urine sitting in your bladder can also develop bladder stones, which can cause infection and irritation.

Also, the higher pressure in your bladder from a constantly full bladder can transmit up to your kidneys and result in kidney damage.

Can overflow incontinence go away?

Many people with overflow incontinence see symptom improvement after treating conditions that cause urinary retention. It’s only in rare instances that people need catheterization.

How can I reduce my risk of overflow incontinence?

Steps like bladder training and double voiding can prevent an overfull bladder from causing leaks. You can also do pelvic floor exercises daily. These exercises strengthen the muscles that support your bladder and urinary system.

What should I ask my provider?

You may want to ask your healthcare provider:

• What is causing my urinary retention and overflow incontinence?
• What did my test results show?
• Are there treatments I can try at home?
• What are the other treatment options?
• Is catheterization or nerve stimulation right for me?
• What are the risks of catheterization or nerve stimulation?