From the Guidelines
Overflow incontinence should be managed with intermittent catheterization or other strategies to prevent complications, rather than indwelling catheterization, which is associated with a high risk of urinary tract infections, urethral erosion, and urolithiasis 1.
Causes and Risk Factors
Overflow incontinence typically occurs due to bladder outlet obstruction or detrusor underactivity, with common causes including:
- Benign prostatic hyperplasia in men
- Urethral strictures
- Neurological conditions like multiple sclerosis or diabetes
- Certain medications
Diagnosis and Evaluation
Patients should be evaluated with post-void residual measurement, and those with residuals over 100-150ml may require intervention 1. A portable ultrasound machine can be used as a non-invasive method for assessing post-void residual 1.
Treatment and Management
Treatment depends on the underlying cause, but may include:
- Catheterization (intermittent or indwelling)
- Alpha-blockers like tamsulosin (0.4mg daily) for men with prostatic obstruction
- Surgery to remove obstructions
- Medications like bethanechol (10-50mg three times daily) to improve bladder contractility for neurogenic causes
- Bladder-training programs, including timed and prompted toileting on a consistent schedule 1
Complications and Prevention
Untreated overflow incontinence can lead to urinary tract infections, bladder stones, or kidney damage due to back pressure, making proper diagnosis and management essential. Indwelling catheters should be assessed daily and removed as soon as possible to minimize the risk of infections 1.
From the Research
Definition and Types of Incontinence
- Overflow incontinence is a type of urinary incontinence where the bladder is not fully emptied, causing urine to leak out 2.
- The most commonly encountered types of incontinence are stress, urge (overactive bladder), and overflow, but anatomic and neurologic causes are important to rule out 2.
Treatment Options for Overflow Incontinence
- Females with overflow incontinence need reduction of outflow resistance and/or improvement of bladder contractility 3.
- Treatment options for overflow incontinence include pharmacotherapy, such as alpha-blockers, parasympathomimetics, and botulinum toxin A 3.
- Tamsulosin, an alpha(1A)- and alpha(1D)-adrenoceptor antagonist, can help improve maximal urine flow and alleviate lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) 4.
Management of Lower Urinary Tract Symptoms
- Initial combined treatment of alpha-blocker plus anticholinergic agent can improve storage symptoms in male LUTS patients with overactive bladder 5.
- However, dose modification is necessary to prevent adverse events, such as dry mouth and acute urinary retention (AUR) 5.
- Tamsulosin has been shown to be effective and well-tolerated in the treatment of LUTS associated with BPH, with a rapid onset of action and low potential for hypotensive effects or interference with concomitant antihypertensive therapy 4.