Symptoms and Treatment Options for Overflow Incontinence
Overflow incontinence is characterized by involuntary leakage of urine due to incomplete bladder emptying, often presenting as frequent small-volume voids and dribbling.1
Symptoms of Overflow Incontinence
- Frequent urination with small volumes of urine, as the bladder never completely empties 1
- Dribbling or constant leakage of urine 2
- Sensation of incomplete bladder emptying 1
- Weak urine stream 2
- Difficulty initiating urination 2
- Nocturia (waking at night to urinate) 3
- Possible abdominal discomfort or distention due to urinary retention 1
Diagnosis
- Post-void residual (PVR) measurement is essential for patients with suspected overflow incontinence 4
- Elevated PVR (typically >250-300 mL) suggests overflow incontinence 4
- Urinalysis should be performed to rule out urinary tract infection and hematuria 4
- Careful physical examination including abdominal, rectal/genitourinary exam to identify possible causes of obstruction 4
Causes of Overflow Incontinence
- Bladder outlet obstruction (e.g., benign prostatic hyperplasia in men) 2
- Neurogenic bladder dysfunction 1
- Detrusor muscle underactivity or acontractility 3
- Medication side effects (e.g., anticholinergics, opioids) 4
- Diabetic neuropathy affecting bladder function 1
Treatment Options
First-line Treatment for Overflow Incontinence Due to BPH
- Alpha-1 blockers (e.g., tamsulosin, alfuzosin) are recommended as first-line pharmacological treatment for overflow incontinence due to BPH 1
- 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) can be added for men with larger prostates (PSA ≥1.5 mg/dL) 1
Management of Neurogenic Causes
- Clean intermittent catheterization is the first-line therapy for overflow incontinence due to neurogenic bladder 1
- Cholinergic agonists (e.g., bethanechol) may help improve bladder contractility in some cases 3
Surgical Options
- Transurethral resection of the prostate (TURP) for men with BPH causing obstruction 2
- Other minimally invasive procedures for prostatic obstruction may be considered 2
Important Cautions
- Antimuscarinic medications used for overactive bladder should be avoided or used with extreme caution in patients with elevated PVR (>250-300 mL) as they may worsen retention 4
- Indwelling catheters should be avoided except as a last resort due to high risk of urinary tract infections, urethral erosion, and urolithiasis 4
- When intermittent catheterization is required, patients must be willing and able to perform the procedure or have caregiver support 4
Follow-up Care
- Regular assessment of treatment efficacy and side effects 4
- Monitoring of post-void residual volumes to ensure improvement 4
- Reassessment if treatment goals are not met 4
Common Pitfalls
- Misdiagnosing overflow incontinence as overactive bladder can lead to inappropriate treatment with antimuscarinics, potentially worsening the condition 4
- Failure to measure post-void residual in patients with incontinence may miss this diagnosis 4
- Not considering medication side effects as potential contributors to overflow incontinence 4