Overflow incontinence describes a type of urinary incontinence. It occurs when the bladder is unable to fully empty during urination, typically due to an obstruction or if muscles are unable to correctly squeeze the bladder. As the bladder cannot empty, it fills up more quickly. This leads to an overflow, which can result in unexpected leakage.

Urinary incontinence refers to the involuntary leakage of urine. It means a person urinates when they do not want to, and often they do not have the urge to urinate before the leak occurs.

There are many types of urinary incontinence. Overflow incontinence differs from the other types. It occurs when a person cannot empty their bladder, or the bladder cannot hold as much urine as the body produces, resulting in an overflow that can lead to leakage.

The inability to retain urine can sometimes lead to discomfort and may result in physical symptoms, such as an increased risk of recurrent urinary tract infections (UTIs).

In this article, we will discuss overflow incontinence, including its symptoms, diagnosis, and treatment options.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Overflow incontinence is the involuntary release of urine because the bladder is too full. It typically occurs when the bladder is unable to empty correctly, so fills up more quickly due to the residual urine. This extra pressure in the bladder causes urine to overflow into the urethra, which can lead to continuous leakage.

People may not feel the urge to urinate and can experience difficulty when trying to pass urine. Individuals may also notice a constant drip or dribbling.

Urinary incontinence has a prevalence of roughly 25–45%, with evidence suggesting that overflow incontinence accounts for 5% of chronic incontinence cases.

Overflow incontinence is one of the several types of urinary incontinence. Each type differs in its cause and presentation. Different types include:

  • Stress incontinence: This refers to when a person experiences increased abdominal pressure on the bladder from sneezing, coughing, or exerting effort, which causes urine to leak. This may be due to a weak urethral sphincter, pelvic floor muscles, or both. Pregnant people and those who have given birth vaginally may be at a higher risk of this type of incontinence.
  • Urge incontinence: This is when a person suddenly feels a strong urge to urinate but cannot hold their urine long enough to reach the toilet. This occurs even if the bladder is not full. Overactivity of the bladder muscles often causes this. This can result from problems with involuntary muscle contractions and is common in people with Alzheimer’s disease, Parkinson’s disease, diabetes, and multiple sclerosis (MS).
  • Mixed incontinence: This type is a combination of urge and stress incontinence. It is more common in females, but may also occur in males who had their prostate removed or have undergone surgery for a large prostate.
  • Reflex incontinence: Similar to urge incontinence, bladder spasms cause this incontinence. However, this type of incontinence causes more leakage. People have involuntary muscle contractions even if they do not feel any urge to urinate. Reflex incontinence is related to a neurological cause or injury, and typically a person with this type may experience a void of their entire bladder contents without warning.
  • Functional incontinence: This type of incontinence involves physical and environmental barriers, such as lacking access to a toilet.

Symptoms of overflow incontinence can include:

  • sudden and involuntary leaking of urine, often in the absence of any urge to urinate
  • dribbling urine
  • frequent, small urinations
  • weak urine stream
  • a feeling of fullness even after urinating
  • difficulty initiating urination
  • not sensing the bladder is full
  • recurrent UTIs

Overflow incontinence happens when the bladder retains too much urine due to problems preventing it from emptying. Potential causes include:

  • Weakness of bladder muscles: If the muscles that control urination cannot squeeze the bladder correctly, it can cause difficulty emptying the bladder.
  • Nerve damage: Injury, surgery, or conditions such as MS, Parkinson’s disease, and spina bifida can affect the nerves, altering the person’s ability to sense a full bladder or reducing the bladder’s ability to contract.
  • Muscle damage: Similarly, damage to the bladder and its muscles may mean the bladder cannot empty fully.
  • A blockage anywhere in the urinary tract: Obstructions can make it difficult to empty the bladder. Blockages can include bladder stones, constipation, and narrowing of the urethra. In males, it can also occur due to an enlarged prostate, prostate cancer, and past surgery.
  • Certain medications: Some medications may cause the bladder to overfill. A 2016 study found that people taking atypical antipsychotics experience similar bladder dysfunction to those with neurological conditions.

While many types of urinary incontinence are typically more prevalent in females, overflow incontinence occurs more often in males, particularly those with prostate problems or who have had prostate surgery.

Typically, a doctor will review a person’s medical history to identify any conditions, past surgeries, or other possible causes that could contribute to incontinence. They may also ask a person to fill out a questionnaire or answer a series of questions about fluid intake, bowel habits, and any other urinary symptoms. They may also ask a person to keep a voiding diary.

Next, they will likely perform a thorough physical exam, which may focus on the abdomen to feel for an enlarged bladder, as well as a rectal or pelvic exam. They may also suggest a neurological exam to assess reflexes.

A doctor may then request other tests to help with the diagnosis. These can include:

  • Post-void residual volume test: This test uses ultrasound to see the amount of urine left in the bladder after voiding.
  • Urinalysis: This test can check for UTIs, blood, protein, or sugar in the urine.
  • Urodynamic test: These tests can look at how well the bladder can hold and empty urine.
  • Pad testing: An absorbent pad can help measure the presence and severity of incontinence.
  • Imaging: These tests can help a doctor view any anatomical or functional problems that may be causing incontinence.

Treatment varies on an individual’s specific needs. They may require one or more of the following:

Behavior training

This involves learning behaviors that may help a person manage or avoid leaks. It can include:

  • Managing fluid intake: Reducing fluid intake and avoiding certain drinks such as alcohol and caffeine can help reduce urine output and decrease the likelihood of an overflow.
  • Bladder training: This method involves waiting for a certain amount of time once a person feels an urge to urinate. Starting with 10 minutes, a person may be able to gradually increase it to a few hours.
  • Scheduled bathroom breaks: Going to the bathroom regularly to urinate can help keep the bladder from overfilling.
  • Double voiding: This technique involves waiting a few minutes after urination before trying to empty the bladder again. This can help drain the bladder completely.
  • Exercises: Pelvic floor exercises can help strengthen the muscles surrounding and supporting the bladder. These muscles are also responsible for stopping urination.

Medication

Alpha-adrenergic blockers such as doxazosin (Cardura), tamsulosin (Flomax), and alfuzosin (Uroxatral) can help relax the muscle at the base of the urethra to allow the urine to drain. Doctors may also give individuals with enlarged prostates 5a reductase inhibitors.

It is important to note that the use of alpha blockers in females is off-label, meaning the doctor has prescribed the medication for a purpose other than what it is approved for.

Products and devices

Catheters are thin, flexible tubes that allow urine to drain out. A doctor typically inserts this tube through a person’s urethra to drain the bladder of urine. In other cases, a doctor may insert a suprapubic catheter, which is a hollow tube inserted into the bladder from a cut from the abdomen.

People with overflow incontinence can also wear adult diapers or adult undergarments designed to absorb leaks. This can be beneficial in particular at night when leaks may occur.

Nerve stimulation

This involves sending electrical impulses to nerves of the bladder muscles to help strengthen them. A healthcare professional may use percutaneous tibial nerve stimulation and sacral nerve stimulation for this purpose.

Surgery

Obstructions and abnormal growth that do not respond to medications may require surgery. For example, while other options are available, males with an enlarged prostate may undergo transurethral resection of the prostate to remove abnormal tissues.

Many people may think that incontinence is a typical part of aging. However, incontinence is both preventable and treatable. People who find incontinence disrupts their daily activities or prevents them from doing things they enjoy should consider talking with their doctors.

Overflow incontinence refers to a type of urinary incontinence where a person cannot completely void their bladder, which can cause leakages. It typically occurs due to blockages or muscles being unable to squeeze the bladder correctly. A doctor can diagnose the cause of a person’s overflow incontinence and discuss treatment options that work for them.