Overflow Incontinence

What is overflow incontinence?

Overflow incontinence (in-KON-teh-nents) is when you leak or dribble urine (pee) because your urinary bladder is too full. You may experience overflow incontinence if you can’t empty your bladder as often as you need to. This might be the case if you find it hard to empty your bladder all the way when you pee.

Some people think leaking pee is a natural part of aging. Getting older may increase your risk of developing overflow incontinence, but it doesn’t mean it’ll happen to you. But overflow incontinence can happen to anyone.

You may feel embarrassed, frustrated or angry about leaks. Those feelings are normal. But overflow incontinence doesn’t have to disrupt your life. It’s important to talk to a healthcare provider so they can make a proper diagnosis and determine the cause. They may recommend natural therapies, medications or other treatment options to help you manage leaks.

What are the types of incontinence?

Overflow incontinence is a rare type of urinary incontinence. More common types of urinary incontinence include:

• Stress incontinence.
• Urge incontinence.
• Mixed incontinence (a combination of stress incontinence and urge incontinence).

How common is overflow incontinence?

In the U.S., as many as 1 in 3 people has some type of urinary incontinence that causes them to leak pee. About 5% of people with chronic (long-lasting) urinary incontinence have overflow incontinence.

What are the symptoms of overflow incontinence?

Overflow incontinence symptoms include:

• Frequent dribbling or leaking of pee.
• Needing to pee a lot (frequent urination), with only small amounts of pee coming out.
• Difficulty starting to pee.
• Starting and stopping while you’re peeing.
• Feeling like you still need to pee even when you can’t anymore.

What is the most common cause of overflow incontinence?

The main cause of overflow incontinence is long-term urinary retention, or too-full bladder. Your bladder is an essential part of your urinary system. It may fill up due to:

• An increase in your pee amount (volume) due to diabetes, medicines like diuretics or other causes.
• A blockage preventing pee from leaving your bladder (bladder outlet obstruction) or passing through the urethra and keeping your bladder from completely emptying.
• Weak bladder muscles or nerve damage.

What are overflow incontinence risk factors?

People assigned male at birth (AMAB) with prostate issues are most likely to develop overflow incontinence after prostate surgery. Conditions like an enlarged prostate (benign prostatic hyperplasia) or prostate cancer can block your urethra, allowing only small amounts of pee to come out when you use the bathroom.

After prostate cancer surgery (prostatectomy), radiation therapy or surgery on your urethra, you can develop scar tissue. Scar tissue can cause a blockage (urethral stricture). If you can’t fully empty your bladder, it fills quickly again. When it gets full, you can leak pee.

You’re also more likely to get overflow incontinence if you have:

• Diabetes.
• Nerve damage.
• A spinal cord injury.

How is overflow incontinence diagnosed?

It’s a good idea to schedule an appointment with a healthcare provider if you have overflow incontinence symptoms. They’ll review your health history, ask questions about your symptoms and perform a physical exam. The physical exam may include a pelvic exam if you have a vagina or a digital rectal exam if you have a prostate.

To help make an accurate diagnosis, the provider may ask you to keep a bladder diary for two to three days. In your bladder diary, you’ll record:

• What you drink.
• How much you drink.
• How often you pee.
• How often you leak pee.
• How much pee you leak.

They may also recommend tests to help make a diagnosis.

What are the tests to see if a person has overflow incontinence?

Tests for overflow incontinence include:

• Urinalysis (urine test or pee test). You’ll provide a pee sample so a healthcare provider can look for problems like urinary tract infections (UTIs) and blood in your pee (hematuria).
• Abdominal ultrasound. This is a type of imaging test that uses high-frequency sound waves to provide detailed pictures of your bladder, kidneys and other organs. This can also check how much pee is left in your bladder after you use the bathroom.
• Cystoscopy. A provider inserts a thin, lighted instrument with a camera at the end (cystoscope) into your urethra to examine your urinary system.
• Voiding cystogram (VCUG). A provider inserts a urinary catheter into your urethra and extends it to your bladder. Then, they insert a contrast dye through the catheter and take an X-ray The dye allows the provider to see what your bladder looks like as it fills up and empties.
• Urodynamic testing. This series of tests helps a provider determine how well your bladder and the rest of your urinary tract hold and release pee. It may also include a post-void residual urine test. A post-void residual urine test measures how much pee remains in your bladder after using the bathroom.

How do you control overflow incontinence?

You may be able to manage overflow incontinence naturally with the following steps:

• Bladder training or timed voiding. You use the bathroom at set intervals throughout the day to prevent your bladder from getting too full, even if you don’t feel the need to go. A good interval to start is two to three hours.
• Double voiding. You try to pee again after you finish peeing. Or you may put more effort into peeing (bear down) to empty your bladder completely.

What are the treatments for overflow incontinence?

Overflow incontinence treatment depends on the exact cause. Your treatment may include:

• Medications. Medications can shrink an enlarged prostate.
• Surgery. A surgeon may need to operate to remove a blockage.
• Self-catheterization (clean intermittent catheterization). You insert a catheter at set times throughout the day to empty your bladder. Once you finish, you remove the catheter.
• Indwelling catheterization. An indwelling catheter remains in your bladder for a long period. Pee flows into a urine drainage bag outside of your body.
• Suprapubic catheter. A surgeon inserts a permanent catheter through your lower abdominal wall, directly into your bladder. Pee collects in a urine drainage bag. A suprapubic catheter avoids your urethra.
• Sacral neuromodulation (nerve stimulation). A provider places a wire through your lower back that floats along the nerve that supplies your bladder. It delivers a gentle, constant stimulation to help your bladder squeeze better. They’ll implant a small battery under your skin.

What medication is used for overflow incontinence?

If an enlarged prostate causes overflow incontinence, a healthcare provider may recommend an alpha-blocker to help shrink your prostate. They may recommend:

• Alfuzosin.
• Doxazosin.
• Silodosin.
• Tamsulosin.
• Terazosin.

What are the complications of overflow incontinence?

People with overflow incontinence leak small amounts of pee. But the leaks are frequent, and they can add up to a large amount of pee by the end of the day.

Absorbent underwear and urinary pads can catch these dribbles. But you may worry about an odor or how they look under your clothes. You may feel self-conscious about going out in public. This can lead to feelings of loneliness (isolation), anxiety and depression. Regular skin exposure to pee can also cause skin rashes and sores.

When your bladder doesn’t empty completely, you’re also at risk of developing UTIs, including bladder, prostate and kidney infections. The excess pee can also cause bladder stones. Bladder stones can cause an infection and irritation or pain.

Pressure from a bladder that’s constantly full can also cause kidney damage.

How can I reduce my risk of overflow incontinence?

Steps like bladder training and double voiding can prevent your overfull bladder from leaking.

Can overflow incontinence go away?

Many people with overflow incontinence see their symptoms improve after treating the conditions that cause urinary retention. It’s only in rare instances that people need a urinary catheter. It’s important to talk to a healthcare provider. They can recommend the most effective ways to manage overflow incontinence and minimize its impact on your life.

How do I take care of myself?

You may wish to wear absorbent underwear or pads until your treatment starts to work. It’s also a good idea to protect your skin from rashes and sores. Petroleum jelly or creams or ointments that contain zinc oxide can prevent irritation.

If overflow incontinence causes you stress, anxiety or depression, you may wish to speak to a therapist (counselor) or psychologist.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider right away if you have any of the following:

• An urge to pee even if you just went to the bathroom.
• Pain in your lower abdomen, lower back or genitals when you pee.
• Difficulty peeing, including trouble starting, a weak pee stream, a stream that starts and stops or an inability to pee at all.
• Signs of an infection, including a fever or chills.
• Blood in your pee.

What questions should I ask a healthcare provider?

You may want to ask a healthcare provider the following questions:

• What’s causing my urinary retention and overflow incontinence?
• What tests do you recommend?
• What did my test results show?
• Are there treatments I can try at home?
• What treatment options do you recommend?
• Is catheterization or nerve stimulation right for me?
• What are the risks of catheterization or nerve stimulation?
• Should I see a urologist?

What are other names for overflow incontinence?

Another name for overflow incontinence is overflow urinary incontinence.

What is the difference between overflow incontinence and urinary incontinence?

Overflow incontinence is a rare type of urinary incontinence. Many different types of urinary incontinence affect your control over your bladder.