Overflow incontinence

Overflow incontinence describes a form of urinary incontinence in which the bladder constantly overflows, just like when a full water barrel is filled further and then overflows drop by drop. In order for this to happen, the bladder must be full to the brim, which is not the rule. After all, we usually go to the toilet as soon as we feel that the bladder is full.

With overflow incontinence, however, chronic urinary retention occurs because a structure blocks the urinary tract. Such structures in men are usually prostate enlargement (prostate hyperplasia). These squeeze the urethra and make extremely high pressures necessary in order to be able to transport any urine at all from the bladder.

This is called a “bladder voiding disorder”. Besides prostate hyperplasia, a tumor of the urethra or narrowing of the urethra can also be responsible for this. While the bladder is completely filled, the bladder closure is always set to “open” because the body wants to empty the bladder.

However, the muscles of the bladder closure are then wrongly accused of not wanting to drain urine from the bladder, when a blockage in the lower urinary tract is responsible for the lack of micturition. At a certain point, the pressure inside the bladder exceeds the pressure in the constricted area, so from time to time urine is involuntarily drained. This is then perceived as incontinence, whereas it is actually a micturition disorder.

The therapy aims to remove the narrowing in the urethra and thus to enable an undisturbed urine flow. A therapy of the bladder closing muscles or the bladder wall muscles is usually not necessary, because they normally still function well. In acute cases, the bladder can also be punctured through the abdominal wall with a long, sterile needle in order to drain the accumulated urine.

This promises immediate relief of the symptoms. Since the accumulation usually occurred over a long period of time, however, too fast drainage of the urine should be treated with caution: The body has usually become accustomed to the obstructed urinary tract over a period of months, which means there is a risk of excessive water loss if the urine is emptied too quickly. In fact, several liters of urine could be pumped through the artificial bladder outlet for days on end, which would, however, disturb the patient’s electrolyte balance. Therefore a slow and controlled emptying of the bladder is important.