Overflow Incontinence

Definition:

Overflow incontinence is dribbling of urine from an over-distended bladder. Leakage is usually slow, but leaks may be constant, resulting in large total losses. Overflow incontinence is the 2nd most common type of incontinence in men (Shenot, 2022).

Pathophysiology

Overflow incontinence occurs in about 5% of chronic incontinence. It does not usually occur unless postvoid residual is > 200-300 mL. The chronic overdistension of the bladder can result from:

• Impaired detrusor contractility
  • Anticholinergic medications can inhibit bladder contraction allowing it to overfill
  • Central and peripheral neurogenic deficit:
    • Multiple sclerosis patients (12%) are affected by urinary retention. Common causes include neurogenic underactive bladder and/or bladder outlet obstruction from detrusor sphincter dyssynergia (Stoffel J. T., 2017)
    • Spinal cord injury
    • Diabetes mellitis impaired bladder sensation, increased residual urine after voiding, and decreased detrusor(bladder muscle) contractility.
• Bladder outlet obstruction
  • Benign prostatic hypertrophy
  • Pelvic organ prolapse: cystocele, rectocele, uterine prolapse, pelvic surgery/trauma
  • Bladder tumor
  • Urethral trauma (stricture)
  • Fecal impaction can also lead to urinary outlet obstruction and chronic bladder distention
  
  

Signs and symptoms:
A large post void residual (PVR), and frequent or constant dribbling, often without recognizable urge or sensation of fullness in the lower abdomen.

Treatment depends on cause (Shenot, P.J., 2022).

• Outlet obstruction
  • Benign prostatic hypertrophy or cancer - drugs or surgery
  • Urethral stricture - dilation or stenting
  • Cystocele - pessary or surgery
  • Fecal impaction - disimpaction
• Detrusor underactivity
  • Bladder decompression
    • intermittent self-cath
    • indwelling catheter
  • Alpha-adrenergic blockers or 5-alpha-reductase inhibitors or surgery may help decrease bladder outlet resistance.

Nursing management

• Catheterization is to be avoided whenever possible
  
• Allow sufficient time for voiding.
• Instruct patient to practice double voiding
• Instruct patient in Crede's maneuver
  
• Review medications for anticholinergics and other meds which can worsen symptoms
  
• Alpha-adrenergic blockers including: doxazosin, prazosin, tamsulosin, and terazosin may be trialed to relax the musculature at the base of the urethra.
  
• Patient with abnormal PVR may require referral to urologist or gynecologist
  
• Patient teaching for intermittent or indwelling catheter as ordered
  
  

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