Overflow Incontinence: What Is It and How Is It Treated?

Medically reviewed by Elaine K. Luo, MD on June 22, 2017Written by Lindsay Ross-Hazel

Is this common?

Overflow incontinence happens when your bladder doesn’t empty completely when you urinate. Small amounts of the remaining urine leak out later because your bladder becomes too full. You may or may not feel the need to urinate before leaks happen. This type of urinary incontinence is sometimes called dribbling.

Besides urine leakage, you may also experience:

  • trouble starting to urinate and a weak stream once it starts
  • getting up regularly during the night to urinate
  • frequent urinary tract infections

Urinary incontinence is most common in older adults. Almost half of Americans age 65 and older have experienced it. Urinary incontinence in general is twice as common in women as in men, but men are more likely than women to have overflow incontinence.

Keep reading to learn more about causes, risk factors, treatment, and more.

What causes this and who is at risk

The main cause of overflow incontinence is chronic urinary retention, which means you can’t empty your bladder. You may need to urinate often but have trouble starting to urinate and completely emptying your bladder.

Chronic urinary retention is more common in men than in women. In men, it’s often caused by benign prostatic hyperplasia, which means the prostate is enlarged but not cancerous.

The prostate is located at the base of the urethra, a tube that carries urine out of a person’s body.

When the prostate becomes enlarged, it puts pressure on the urethra, making it harder to urinate. The bladder can also become overactive, making a man with an enlarged bladder feel the urge to urinate often.

Over time, this can weaken the bladder muscle, making it harder to empty the bladder completely. The urine remaining in the bladder makes it become full too often, and urine leaks out.

Other causes of overflow incontinence in men and women include:

  • bladder stones or tumors
  • conditions that affect the nerves, like multiple sclerosis (MS), diabetes, or brain injuries
  • previous pelvic surgery
  • certain medications
  • severe prolapse of a woman’s uterus or bladder

How it compares to other types of incontinence

Overflow incontinence is one of several types of urinary incontinence. Each has different causes and characteristics:

Stress incontinence: This happens when physical activity, like jumping, laughing, or coughing, causes urine to leak. Possible causes are weakened or damaged pelvic floor muscles, urethral sphincter, or both. Usually, you don’t feel the need to urinate before leaks happen. Women who’ve delivered a baby vaginally may be at risk for this type of incontinence because pelvic floor muscles and nerves can be damaged during childbirth.

Urge incontinence (or overactive bladder): This causes a strong, sudden need to urinate even if your bladder isn’t full. You might not be able to make it to the bathroom in time. The cause is often unknown, but it tends to happen to older adults. In some cases, it’s a side effect of infections or certain conditions, like Parkinson’s disease or MS.

Mixed incontinence: This means you have both stress and urge incontinence. Women with incontinence usually have this type. It also occurs in men who have had their prostate removed or have had surgery for an enlarged prostate.

Reflex incontinence: This is caused by damaged nerves that can’t warn your brain when your bladder is full. It usually happens to people with severe neurological damage from:

Functional incontinence: This happens when an issue unrelated to the urinary tract causes you to have accidents. Specifically, you are unaware you need to urinate, can’t communicate that you need to go, or are physically unable to get to the bathroom in time. Functional incontinence can be a side effect of:

Diagnosing overflow incontinence

Your doctor may ask to you keep a bladder diary for a week or so prior to your appointment. A bladder diary can help you find patterns and possible causes for your incontinence. For a few days, record:

  • how much you drink
  • when you urinate
  • the amount of urine you produce
  • whether you had an urge to urinate
  • the number of leaks you had

After discussing your symptoms, your doctor may perform diagnostic testing to figure out the type of incontinence you have:

  • A cough test (or stress test) involves coughing while your doctor checks to see if urine leaks.
  • A urine test looks for blood or signs of infection in your urine.
  • A prostate exam checks for an enlarged prostate in men.
  • A urodynamic test shows how much urine your bladder can hold and whether it can empty completely.
  • A post-void residual measurement checks how much urine is left in your bladder after you urinate. If a large amount remains, it could mean you have blockage in your urinary tract or a problem with the bladder muscle or nerves.

Your doctor may also recommend additional tests, like a pelvic ultrasound, radionuclide cystogram, or cystoscopy.

Treatment options

Depending on your specific needs, your treatment plan could include one or more of the following:

At-home behavioral training

At-home behavioral training can help you teach your bladder to control leaks.

  • With bladder training, you wait a certain amount of time to urinate after you feel an urge to go. Start by waiting 10 minutes and try to work your way up to only urinating every two to four hours.
  • Double voiding means that after you urinate, you wait a few minutes and try to go again. This can help train your bladder to empty completely.
  • Try scheduled bathroom breaks, where you urinate every two to four hours instead of waiting to feel an urge to go.
  • Pelvic muscle (or Kegel) exercises involve tightening the muscles you use to stop urinating. Tighten them for 5 to 10 seconds, and then relax for the same amount of time. Work your way up to doing 10 reps, three times a day.

Products and medical devices

You may be able to use the following products to help stop or catch leaks:

Adult undergarments are similar in bulk to normal underwear but absorb leaks. You can wear them under everyday clothing. Men may need to use a drip collector, which is absorbent padding held in place by close-fitting underwear.

A catheter is a soft tube you insert into your urethra several times a day to drain your bladder.

Inserts for women can help with different incontinence-related issues:

  • A pessary is a stiff vaginal ring you insert and wear all day. If you have a prolapsed uterus or bladder, the ring helps hold your bladder in place to prevent urine leakage.
  • A urethral insert is a disposable device similar to a tampon that you insert into the urethra to stop leaks. Put it in before doing any physical activity that usually causes incontinence, and remove it before urinating.

Medication

These medications are commonly used to treat overflow incontinence.

Alpha-blockers relax muscle fibers in a man’s prostate and bladder neck muscles to help the bladder empty more completely. Common alpha-blockers include:

Anticholinergics help prevent bladder spasms. Common anticholinergics include:

Mirabegron (Myrbetriq) relaxes the bladder muscle. It can help your bladder hold more urine and empty more completely.

Patches deliver medicine through your skin. Oxybutynin (Oxytrol) is a common urinary incontinence patch that helps control bladder muscle spasms.

Low-dose topical estrogen can come in a cream, patch, or vaginal ring. It may help women restore and tone tissue in the urethra and vaginal areas to help with some incontinence symptoms.

Interventional therapies

Interventional therapies may be effective if other treatments haven’t helped with your symptoms. There are a few types of interventional therapies for urinary incontinence. The one that is most likely to help with overflow incontinence involves getting injections of a synthetic material, called bulking material, in the tissue around the urethra. This helps keep your urethra closed, which can reduce urine leakage.

Surgery

If other treatments aren’t working, surgery may be an option, including:

Outlook

If you have overflow incontinence, talk to your doctor about treatment options. You might have to try a few methods before you find one that works for you, but it’s often possible to manage your symptoms and minimize interruptions to your daily life.

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