What is overflow incontinence?

Overflow incontinence is leakage of urine from a chronically over-distended bladder - the bladder fails to empty and overflows.

It results from outflow obstruction (e.g. a large prolapse, pelvic mass) or an underactive/atonic detrusor (e.g. neurological causes, after surgery, some medications). There is often incomplete emptying with a high post-void residual; management treats the cause (+/- catheterisation).

Clinical relevance. Recognising overflow incontinence (high residual, bladder fails to empty) directs treatment of the obstruction/atony and bladder drainage.

More Detail

Overflow incontinence

Overflow incontinence is leakage from a bladder that cannot empty.

What it is

• Leakage from a chronically over-distended (full) bladder that fails to empty - urine overflows when bladder pressure exceeds urethral resistance.
• Often continuous dribbling or leakage with a high post-void residual volume.

Causes

• Outflow obstruction - e.g. a large pelvic organ prolapse, pelvic mass, or urethral stricture.
• Detrusor underactivity/atonic bladder - neurological disease (e.g. diabetic neuropathy, spinal pathology), after pelvic surgery, or some medications.

Assessment

• Post-void residual measurement (high); bladder may be palpable.

Management

• Treat the underlying cause (relieve obstruction, review medications).
• Bladder drainage - intermittent (or indwelling) catheterisation to empty the bladder and prevent damage/back-pressure on the kidneys.