Overflow incontinence is the involuntary loss of urine when the bladder is unable to empty properly due to a bladder outflow obstruction (BOO) or an underactive detrusor muscle (UAB). These symptoms are often described as lower urinary tract symptoms (LUTS).
LUTS is a term used to describe a range of symptoms related to the Lower Urinary Tract (bladder, prostate and urethra). LUTS are broadly grouped into obstructive symptoms or irritative symptoms.
It is also often used to describe prostatism (a disorder resulting from obstruction of the bladder neck by an enlarged prostate gland) and therefore more commonly used for men who have lower urinary tract symptoms. LUTS can also affect women mainly by chronic constipation, obstruction from a pelvic organ prolapse or stricture.
LUTS can be divided into groups
Storage (irritative)
In this group we find bladder problems like increased frequency, urgency, urgency incontinence and nocturia. Nocturia means increased voiding at night.
Voiding (obstructive)
This group includes symptoms of voiding difficulty such as weak urinary flow, hesitancy and straining.
Post micturition symptoms (obstructive)
Incomplete emptying / residual urine and dribbling are examples of post micturition symptoms.
Underactive bladder/bladder failure
Underactive bladder is where the bladder muscle (detrusor) is unable to contract effectively and fully empty. This can lead to residual urine remaining inside the bladder.
Symptoms: Weak urinary flow, hesitancy, straining, reduced bladder sensation, abdominal distension with/without discomfort, nocturnal enuresis, recurrent UTI’s.
Examination and investigations
Patients with LUTS should have abdominal palpation examination, a digital rectal examination to assess the prostate and assessment for post void residual urine which could include a palpable or percussible bladder or alternatively use of a bladder scanner.
A bladder diary is very useful. This involves patients recording the time and volume of each void and the volume, type and time of fluid intake. This should be completed for at least three days.
Urinalysis or MSU to be considered if suspicious of urinary tract infection (UTI). Patients may be referred for further investigations such as Uroflowmetry or Urodynamics.