overflow incontinence

Introduction

The involuntary loss of urine associated with overdistension of the bladder.

Etiology

• outlet obstruction
  • benign prostatic hypertrophy (BPH)
  • prostatic tumor
  • stricture
  • prolapsed cystocele
• underactive bladder
  • weakness of the detrusor muscle
  • peripheral nerve disease at the sacral level
• impaired bladder sensation
  • diabetic neuropathy
  • multiple sclerosis

Pathology

• urinary retention that causes the capacity of the bladder to be overwhelmed, resulting in continuous or intermittent leakage of a small amount of urine

Clinical manifestations

• a continuous dripping or dribbling incontinence
• decreased force of urinary stream
• prior symptoms of urinary obstruction may be noted
• other manifestations of peripheral nerve disease may be present

Laboratory

• catherization reveals a large post-void residual volume
• urinalysis
• urodynamic testing is indicated

Complications

• disease interaction(s) of alcohol intoxication with overflow incontinence
• disease interaction(s) of vitamin B12 deficiency with urinary incontinence
• disease interaction(s) of constipation with urinary incontinence
• disease interaction(s) of peripheral vascular disease with overflow incontinence

Management

• general - see urinary incontinence & urinary retention for general measures
• maneuvers to facilitate bladder emptying
  • Crede maneuver (suprapubic external compression)
  • Valsalva maneuver
  • double voiding
  • triggered (timed) urination
• pharmacologic agents
  • alpha-adrenergic receptor antagonists
    • reduce sphincter resistance* {both men & women}
    • prazosin (Minipress) 1-5 mg TID
    • terazosin (Hytrin) 1-5 mg QHS
    • doxazosin (Cardura) 1-4 mg QHS
    • tamsulosin (Flomax) 4-8 mg QHS
  • cholinergic agents (stop anticholinergic agents)
    • improve detrusor muscle contractility
    • bethanechol (Urecholine) 10-50 mg TID/QID
    • cholinestesterase inhibitor
  • anti-androgen therapy
    • regression of hyperplastic prostate tissue
    • 2-6 months may be required before improvement of symptoms
    • finasteride (Proscar) 5 mg QID
• surgery
  • indications: benign prostatic hypertrophy
  • procedures
    • transurethral resection of the prostate (TURP)
    • transurethral incision of the prostate (TUIP)
    • transurethral ultrasound-guided laser-induced prostatectomy (TULIP)
• intermittent or chronic catheter drainage

* blocking alpha receptors in the bladder relaxed the internal urethral sphincter

More general terms

• urinary incontinence (UI)

Additional terms

• underactive bladder; bladder atony
• urinary retention