Guide To Overflow Incontinence / HARTMANN Information Centre

The HARTMANN Team

Introduction

Incontinence is common problem experienced by an estimated 3 to 6 million people in the UK. Though it is an issue faced by many, it still remains a cause of shame and embarrassment for those with the condition. Overflow incontinence is one of the most common forms of incontinence, and it can often be a symptom of an underlying condition.

Read our comprehensive guide to overflow incontinence to learn about how you can prevent, diagnose and manage this affliction.

What Is Overflow Incontinence?

Overflow incontinence is a common form of incontinence, something that is defined as the inability to control the bladder and urination in general. While incontinence can have many causes and come in many forms, overflow incontinence is the result of being unable to empty your bladder fully. As a result, the overflow that is left over can at times come leaking out without your knowledge or control. You may not even know that your bladder is full or that you urgently need the toilet.

The resulting urine leakage can cause many problems for the sufferer. The initial problem is a sense of wetness and discomfort, which can feel uncomfortable and cause chafing and rashes. The smell and sight of urine on one’s clothing can cause a sense of severe embarrassment, and can lead to a withdrawal from social settings and an impact on employment. The urine that remains in the bladder becomes a fertile ground for bacteria to grow and breed. These bacteria can then cause repeated urinary tract infections and kidney issues.

While a wide variety of incontinence products are available, it is still important to determine the underlying cause of overflow incontinence, and treat the condition.

What Causes Overflow Incontinence?

While both men and women can suffer from overflow incontinence, this is an illness that affects men more often.

The most common causes include (but are not limited to):

  • Urethral blockages – The urethra is the tube that carries urine from the bladder to the genitals, and it can become blocked for a variety of reasons. These blockages can be caused by tumours, kidney stones, bladder stones, swelling, infection, scar tissue or kinks in the urethra caused by the bladder dropping within the abdomen.
  • An enlarged prostate – This is one of the most common causes of overflow incontinence.
  • Nerve damage or injury – Many different diseases and conditions can cause nerve damage, including Parkinson’s disease, alcoholism, diabetes, multiple sclerosis and spina bifida.
  • Weak bladder muscles – If your bladder muscles are too weak, you may be unable to efficiently squeeze your bladder to a fully empty state.
  • Certain medications – Some medications can affect the nerve signals that are sent to the bladder. These can include anticonvulsants, certain antidepressants, and painkillers.

Urinals

When Should You Seek Medical Advice

You should always seek medical advice if you experience any unexplained changes in your urination habits. If you have any problems with incontinence, it is time to make an appointment with your GP. They will conduct urinalysis and ask you many questions related to your lifestyle, diet and toilet habits. They may then refer you onto a specialist in the bladder and urethra, called a urologist.

Diagnosis Of Overflow Incontinence

Once you have made an appointment with a GP or urologist for incontinence, they will ask you many questions to determine the type of incontinence you are suffering with.

Some of the questions will include:

  • How many times per day do you use the toilet?
  • While you are urinating, can you easily stop and start the flow of urine?
  • Do you have leakage at certain times, or is it constant?
  • Do you get up many times in the night to use the toilet?
  • Do you leak urine more when engaging in certain activities?
  • Do you feel any burning or pain when you urinate?
  • How many times have you had a urinary tract infection?
  • Do you take any medications? If so, which ones?
  • Have you ever had a back injury?
  • What medical conditions do you have, and could these be causing problems with your bladder function?
  • Do any specific foods or drinks seem to trigger the problem?

After these questions, your GP will then conduct a physical examination of your abdomen and urethra. They will be looking for any signs of nerve damage that may be negatively affecting your rectum, bladder and urethra. At this point, your GP may refer you on to a urologist. If they suspect that something may be affecting your nerves, they may refer you to a neurologist.

Specific Tests to Diagnose Overflow Incontinence

The GP or specialists may order one or more of the following tests to determine the problem and make a diagnosis.

  • A stress test - Your GP or urologist will ask you to cough while they check if you are losing urine.
  • Catheterisation – Your doctor will ask you to relieve yourself and fully empty your bladder, and then they will insert a catheter into your bladder in order to assess if any more urine is leaking out. If this is the case, it indicates overflow incontinence.
  • Urinalysis and urine culture – Your GP or urologist will send a sample of your urine to the lab, and a technician will test it for infection, abnormalities, or kidney stones.
  • An ultrasound – You might be sent for an ultrasound (an imaging test) in order to get a clear picture of your bladder, ureters (the tubes that carry urine to the bladder from the kidneys) and kidneys, and to assess how much urine is remaining in your bladder after you urinate.
  • A cystoscopy – A urologist might perform a cystoscopy, a test that gives a clear picture of the inside of your bladder using a cytoscope (a microscopic camera).
  • A CT scan – A CT scan can be conducted to evaluate the health of your kidneys and bladder.
  • Intravenous pyelogram (IVP) – In this procedure a doctor will inject a special solution into one of your veins, and then an X-ray of your kidneys, ureters, and bladder will be taken.

After these tests, if a clear diagnosis is still not possible, you may be sent for urodynamic testing. This testing will examine and evaluate your bladder contractions, overall pressure, nerve signals, urine flow, and any resulting leakage.

How To Treat / Manage Overflow Incontinence

As mentioned above, overflow incontinence is more common in men than in women. While it can be hard to eradicate completely, it can be managed and treated. The first course of action is lifestyle changes, as your GP or urologist will try to determine if any aspects of your diet or exercise regime are causing the problem.

For men who are suffering from overflow incontinence as the result of an enlarged prostate, they can often find relief with a specific class of medication called alpha-adrenergic blockers. These include terazosin (Hytrin), doxazosin (Cardura), tamulosin (Flomax), alfuzosin (Uroxatal), Minipress, silodosin (Rapaflo), and fesoterodine (Toviaz). These medications work by helping to relax the muscles at the base of the urethra, allowing urine to more easily pass from the bladder.

If these medications do not relieve the issue, then you might be instructed to use a catheter. This is a thin tube that is inserted into the urethra and then is emptied into the toilet when you go to the loo. This is something that you can do by yourself; a doctor or nurse will show you the process. Single use catheters are available, allowing you to dispose of the tubes each time you use them.

If your overflow incontinence is caused by a blockage (a tumour, kidney stone or other abnormality) you may require surgery to address and correct the problem.

Summary

While overflow incontinence is common, those who suffer with the problem face embarrassment, discomfort and repeated infection. For your comfort and quality of life, it is important to speak to your GP as soon as you notice any symptoms of incontinence.

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