Contents

Search

overflow incontinence

The involuntary loss of urine associated with overdistension of the bladder. Etiology: 1) outlet obstruction a) benign prostatic hypertrophy (BPH) b) prostatic tumor c) stricture d) prolapsed cystocele 2) underactive bladder a) weakness of the detrusor muscle b) peripheral nerve disease at the sacral level 3) impaired bladder sensation a) diabetic neuropathy b) multiple sclerosis Pathology: - urinary retention that causes the capacity of the bladder to be overwhelmed, resulting in continuous or intermittent leakage of a small amount of urine Clinical manifestations: 1) a continuous dripping or dribbling incontinence 2) decreased force of urinary stream 3) prior symptoms of urinary obstruction may be noted 4) other manifestations of peripheral nerve disease may be present Laboratory: 1) catherization reveals a large post-void residual volume 2) urinalysis 3) urodynamic testing is indicated [5] Management: 1) general - see urinary incontinence & urinary retention for general measures 2) maneuvers to facilitate bladder emptying a) Crede maneuver (suprapubic external compression) b) Valsalva maneuver c) double voiding d) triggered (timed) urination [4] 3) pharmacologic agents a) alpha-adrenergic receptor antagonists [6] - reduce sphincter resistance* {both men & women} - prazosin (Minipress) 1-5 mg TID - terazosin (Hytrin) 1-5 mg QHS - doxazosin (Cardura) 1-4 mg QHS - tamsulosin (Flomax) 4-8 mg QHS b) cholinergic agents (stop anticholinergic agents) - improve detrusor muscle contractility - bethanechol (Urecholine) 10-50 mg TID/QID - cholinestesterase inhibitor c) anti-androgen therapy - regression of hyperplastic prostate tissue - 2-6 months may be required before improvement of symptoms - finasteride (Proscar) 5 mg QID 4) surgery a) indications: benign prostatic hypertrophy b) procedures - transurethral resection of the prostate (TURP) - transurethral incision of the prostate (TUIP) - transurethral ultrasound-guided laser-induced prostatectomy (TULIP) 5) intermittent or chronic catheter drainage * blocking alpha receptors in the bladder relaxed the internal urethral sphincter [5]

Interactions

disease interactions

Related

underactive bladder; bladder atony urinary retention

General

urinary incontinence (UI)

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 528-30
  3. Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 82-83
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  5. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  6. Prescriber's Letter 10(4):20-21 2003