Overflow Incontinence: Causes, Symptoms & Treatment

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.

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 therapies
  Conservative therapies, such as lifestyle changes and non-surgical medical treatments, can resolve up to 25% of incontinence cases and are often the first line of treatment.
• Bladder training with biofeedback
  If you have some control over your bladder, you may benefit from bladder training with biofeedback. This involves keeping a bladder diary to track how often you go to the toilet, then gradually increasing the time between visits using timed voiding.
• Pelvic floor (Kegel) exercises - Kegels or pelvic floor exercises using NMES - neuromuscular electrical stimulation means the muscles are built back to strength automatically. 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
  Bethanechol chloride is an oral medication that stimulates the bladder muscle to contract, helping with certain types of urinary retention. However, it is now used less commonly, as its effectiveness is limited and it has largely been replaced by more effective treatments. It may still be prescribed in specific cases under specialist guidance. 

Improve bowel control & strengthen the pelvic floor in just 12 weeks, with the help of the Kegel8 Ultra 20 & Amanda Savage!

Amanda Savage is one of the UK’s leading specialist pelvic floor and women’s health physiotherapists, who has worked in the field for over 20 years offering supervised pelvic floor muscle training and support for the recovery of pelvic organ prolapses, incontinence and pelvic surgeries. With post-graduate qualifications, including a master’s degree from the University of Cambridge, she has also gained full membership of the Professional Network of Pelvic, Obstetric & Gynaecological Physiotherapy (POGP). As a Kegel8 ambassador, Amanda Savage has worked alongside us for many years in the development of our best-selling device, the Kegel8 Ultra 20 V2 Electronic Pelvic Toner, to ensure its efficacy. In addition, she has been integral to ensuring all supporting information and instructions are medically accurate so that the device is used correctly/effectively, and treatment is tailored to the specific condition of the user.

Comes complete with an easy exercise plan, created by Amanda Savage, to get results in 12 weeks!

After surgery you will want to get back to your normal routine as soon as possible. However, gynaecological surgery can have an incredible impact on pelvic floor muscles, with many women often finding that they feel weak, unsupported, or de-conditioned in the weeks following their operation. Doing regular pelvic floor exercise sessions several times a day, straight away after your surgery, will help the healing process by improving blood circulation to the area, reducing swelling, and strengthening your muscles so they can support you. The next step is to build up good muscle strength and endurance again which you need for secure bladder and bowel control. Exercises will also improve the muscle tone which we need to prevent pelvic organ prolapse, to feel supported.

In the first 12 weeks after your surgery, you should perform pelvic floor exercises, but as the body is healing and sensations can be altered, it is not advised to use a muscle STIM device. Instead, perform your Kegels independently. However, after 12 weeks post-op, it is safe to use the Kegel8® Ultra 20 and follow the simple 12-week plan, which promises more effective pelvic floor exercise. The Kegel8 Ultra 20 V2 Electronic Pelvic Toner removes the guesswork and essentially acts as a Sat-Nav for your pelvic floor muscles, correctly targeting and stimulating a contraction within them using a small electric current. These contractions build strength and tone in a matter of weeks! With 20 clinically proven pelvic floor exercise programmes which vary in frequency, intensity and duration, the Ultra 20 is proven to treat a variety of different conditions and has been shown to be effective for rehabilitation post-surgery. And, in addition to tailored programmes, the specific 12-week exercise plans created by Amanda Savage advise exactly how the device should be used, depending upon the user’s specific requirements/condition, to ensure the very best treatment.

You’ll find an easy 12-week exercise plan created by Amanda Savage to aid pelvic floor rehabilitation post gynaecological surgery included with your Kegel8 Ultra 20. It utilises a unique combination of programmes to help the healing process by improving blood circulation to the area, reducing swelling, and strengthening your muscles so they can support you. It subsequently builds up good muscle strength and endurance again, which is needed for secure bladder and bowel control, and it will calm the ‘jumpy’ nerves responsible for a sensitive bladder. This plan will also improve the muscle tone which we need to prevent pelvic organ prolapse, to feel supported.

Sources

Bladder & Bowel Community. (2024). Overflow Incontinence. [online] Bladder & Bowel Community, 2024. [viewed 13/11/24]. Available from: https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/overflow-incontinence/

Khandelwal, C. Kistler, C. (2013). American Family Physician. Diagnosis of Urinary Incontinence. [online] 87(8), p543-550. [viewed 13/11/24] Available from: https://www.aafp.org/pubs/afp/issues/2013/0415/p543.html

National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Prostate Enlargement (Benign Prostatic Hyperplasia).[online] National Institute of Diabetes and Digestive and Kidney Diseases, 2024. [viewed 13/11/24]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/enlarged-prostate-benign-prostatic-hyperplasia?dkrd=/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia

National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Bladder Control Problems in Men (Urinary Incontinence)[online] National Institute of Diabetes and Digestive and Kidney Diseases, 2024. [viewed 13/11/24]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems?dkrd=/health-information/urologic-diseases/bladder-control-problems-men

NHS Trust (2022). Bladder Stones: Causes [online] NHS Trust, 2022. [viewed 13/11/24]. Available from: https://www.nhs.uk/conditions/bladder-stones/

NHS. (2023). Urinary catheter: Living with. [online] NHS Trust, 2023. [viewed 13/11/24]. Available from: https://www.nhs.uk/tests-and-treatments/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 13/11/24]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC1472851/