Overflow Urinary Incontinence

Overflow incontinence is when you are unable to fully empty your bladder, leaving you with a feeling of a full bladder even after you use the toilet. As your bladder is never fully empty, you more frequently 'top it up' and need to urinate. When you do urinate, your stream is weak and slow and may continue to dribble for a while after you feel finished. Sometimes you will not feel the sensation of your bladder being full, meaning you often leak and can even wet the bed at night.

Men are more likely to suffer from overflow incontinence than women, with the most common causes relating to prostate problems.

If you postpone treatment for your overflow incontinence, you can suffer from kidney damage (resulting in more urine being produced), bladder stones (created from the chemicals in your urine), and recurring urinary tract infections (if your bladder is consistently full of urine, you are at risk of bacteria causing recurring urinary tract infections.)


Symptoms of Overflow Urinary Incontinence

You may be suffering from overflow incontinence if you:

  • frequently leak urine without any warning
  • have difficulty emptying your bladder, with a weak or intermittent flow which may dribble after you feel finished
  • have the sensation to visit the toilet frequently
  • wake up in the night to urinate more than twice (nocturia)
  • strain your abdomen in order to urinate, and/or contract and relax your pelvic floor muscles several times in an effort to empty your bladder

It is important that you seek diagnosis from your GP as early as possible. It may be that you are experiencing overflow incontinence due to another condition which needs resolving. Such as prostate enlargement (in men), blocking the urethra to prevent urine from exiting. Or diabetes mellitus and insipidus, which cause an overproduction of urine.


Causes of Overflow Urinary Incontinence

Overflow incontinence is caused when the muscles around your bladder are not able to squeeze the bladder empty, and/or your urethra is blocked. This commonly occurs as a result of nerve or muscle damage. Because you can't empty your bladder completely, the bladder and its associated muscles become slack and less controlled which leads to you often leaking urine.

  • Blocked urethra - The urethra carries urine from the bladder to the outside. It can become obstructed by multiple things, including; a pelvic organ prolapse (in women only), an enlarged prostate (in men only), constipation, or a kidney stone. As a result, the bladder is prevented from emptying properly.
  • Weak bladder muscles - Having a weak detrusor muscle means it is unable to contract fully, in order to fully empty your bladder.
  • Pelvic surgery or trauma - If any mistakes are made during surgery, they will be resolved in the same operation wherever possible. However due to the proximity of the pelvic organs, you will often experience issues following any pelvic surgery. If any other event results in physical trauma to your bladder muscles, you can also suffer.
  • Muscle or nerve damage - Damage can occur as a result of many conditions and events, including diabetes, alcoholism, multiple sclerosis, spinal damage and Parkinson's disease. If you suffer from nerve damage around your bladder, your muscles may be unable to contract as needed to fully empty your bladder.
  • Some prescription medications - Some anti-convulsants and anti-depressants can affect the nerve signals to the bladder, preventing it from contracting. Diuretic medications can cause more urine to be produced.

To read more about these causes, and the events that can lead to you developing any form of urinary incontinence, visit the Causes and Diagnosis page.


How to Stop Overflow Urinary Incontinence

5% of individuals diagnosed with overflow incontinence, will be diagnosed with chronic incontinence, meaning their symptoms cannot be alleviated with conservative therapy's alone. This is usually as the cause of the original incontinence remains. Therefore, treatments for overflow incontinence look to improve the strength of the bladder muscles, giving you more control:

Conservative therapy's - Conservative therapy's, such as lifestyle changes and non-surgical medical treatments, resolve 25% of incontinence cases, and are the first course of treatment.

  • Bladder training with biofeedback - If you have control over the functions required to empty your bladder, you can try bladder training with biofeedback. This technique uses a bladder diary to recognise how often you use the toilet. You can then introduce time voiding, a technique to increase the intervals between going to the toilet.
  • Pelvic floor (Kegel) exercises - Kegels or pelvic floor exercises are essential. Results can take up to 3 months, and the resulting strong pelvic floor muscles mean that your bladder and pelvic organs won’t sag and cause leaks. These exercises are a must if you have a blockage that is caused by either a bladder prolapse or prolapsed urethra.
  • Reduce or modify your diuretics - With supervision from a health professional, you can consider lowering or modifying the dose of any medication you are taking, to avoid the unwanted side effects of diuretics.
  • Catheter - Whilst the original cause is treated, you may opt to have a catheter fitted, which drains your bladder to keep it empty to avoid infections. The catheter will likely be fitted by a professional, but they may teach you how to self catheterise at intervals to alleviate pressure.
  • Prescription of bethanechol chloride - This orally administered drug increases the tone of your bladder muscle and its ability to contract. It works within an hour of administration and therefore its benefits are often seen within just a few days.

To read about the other treatments available for general urinary incontinence, visit our incontinence treatment page.


Sources

Bladder & Bowel Community. (2018). Overflow Incontinence. [online] Bladder & Bowel Community, 2018. [viewed 20/04/18]. Available from: https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/overflow-incontinence/

Gormley, E. A. Lightner, D. J. Burgio, K. L. Chai, T. C. Clemens, J. Q. Culkin, D. J. Das, A. K. Foster Jr, H. E. Scarpero, H. M. Tessier, C. D. Vasavada, S. P. (2012) The Journal of Urology. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. [online] 188(6), p2455-2463. [viewed 20/04/18]. Available from: http://www.jurology.com/article/S0022-5347(12)04959-2/pdf

Khandelwal, C. Kistler, C. (2013). American Family Physician. Diagnosis of Urinary Incontinence. [online] 87(8), p543-550. [viewed 23/04/18] Available from: https://www.aafp.org/afp/2013/0415/p543.html

National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Prostate Enlargement (Benign Prostatic Hyperplasia).[online] National Institute of Diabetes and Digestive and Kidney Diseases, 2014. [viewed 23/04/18]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia

National Institute of Diabetes and Digestive and Kidney Diseases. (2015). Bladder Control Problems in Men (Urinary Incontinence)[online] National Institute of Diabetes and Digestive and Kidney Diseases, 2015. [viewed 23/04/18]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-men

NHS Trust (2015). Bladder Stones: Causes [online] NHS Trust, 2015. [viewed 25/04/18]. Available from: https://www.nhs.uk/conditions/bladder-stones/causes/

NHS. (2017). Urinary catheter: Living with. [online] NHS Trust, 2017. [viewed 20/04/18]. Available from: https://www.nhs.uk/conditions/urinary-catheters/living-with/

Yoshimura, N. Chancellor, M. B. (2004) Reviews in Urology. Differential diagnosis and treatment of impaired bladder emptying. [online] 6(supplement 1), pS24-31. [viewed 20/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472851/