What are the symptoms of overflow incontinence?

There are many devices and products that collect and hold urine. They help manage urinary retention and urinary incontinence. With urinary retention, your bladder does not completely empty. With urinary incontinence (UI), you have urine leakage that you cannot control.

Products and devices can help men and women of all ages. For some people, they are the only way to manage bladder problems. These devices can also give older and disabled persons more freedom.

Indwelling Catheters

A catheter is a flexible tube placed in your bladder. An "indwelling" catheter stays in your bladder all day and night. There are two types of indwelling catheters. Indwelling "Foley" catheters are placed in your urethra. Indwelling "suprapubic" catheters go above your pubic bone through a small surgical cut in the belly. With both types, a balloon holds the tube in your bladder. They both also drain urine into a bag outside the body.

A health care provider will place the Foley catheter in your urethra. The catheter can be managed by home care nurses when used long term. A urologist places the suprapubic catheter with minor surgery.

A Foley catheter should only be used for less than 2 years. If you need an indwelling catheter for a longer period of time, you should consider a suprapubic catheter. Because the suprapubic catheter is only in the bladder, there is less risk of bacteria growing (because it is away from the vagina and rectum). That means less risk of urinary tract infections, especially in women.

Both Foley and suprapubic catheters need to be replaced with a new catheter at least once every month. This also lowers the risk of infection. Both catheters can cause complications if used for a long time. Bladder, testicle (males), and kidney infections, bladder stones and bladder cancer can occur. Foley catheters can cause permanent damage to the urethra.

Foley and suprapubic catheters should be taped or strapped to the upper thigh or lower belly. This lowers the chance of injury if the catheter is tugged accidentally.

Catheters are made from latex with Teflon coating or silicone. The choice depends on a person's allergies and the health care provider's preference. Some catheters are coated with antibiotics to prevent infection. There is debate about whether this works.

Indwelling catheters vary in shape, tube size and tip. They are sized using the French (Fr) scale. Size 14 Fr is the most common size. A balloon is inflated once the catheter is inserted. This keeps the catheter from falling out. The balloon is usually filled with about 2 teaspoons of sterile water.

External Collecting Systems

For men, there are external collecting systems called condom or Texas catheters. These special condoms are rolled over the penis. They are kept in place by adhesive or straps. The condoms have holes at the tip. A tube goes from the hole to a drainage bag. Urine from incontinence collects in the drainage bag. Newer condoms are usually silicone. They come in sizes, with a sizing guide.

This device may be hard to use if you have problems with finger dexterity. A caregiver or family member would need to apply the condom catheter. Adhesive pouches may be better for men whose penis has retracted (drawn back).

An external collection device for women funnels urine from a pouch through a tube to a collecting device. These must be stuck to the outside of the labia. They are rarely used as the labia do not form a good water tight seal, so urine leaks.

Urine Drainage Bags

Both indwelling and external collecting devices are connected to drainage bags. They collect urine coming out of the bladder. Drainage bags come in different sizes. Overnight bags hold 1500 to 2000 milliliters (1.5 to 2.0 liters) of urine. These are large and cannot be hidden.

A leg bag is a smaller drainage bag. It holds 500 to 800 milliliters. It allows more freedom of movement. It can be hidden under clothing. It can be strapped to the thigh or calf. A new type, called the Belly Bag, is strapped to the belly. Drainage bags work by gravity. So they should be strapped somewhere below the bladder.

When choosing a bag, make sure the strap is not too restrictive or tight. The valve that drains urine from the bag should be easy to open.

Drainage bags can be cleaned and deodorized. Soak 20 minutes in a solution of two parts vinegar and three parts water.

Catheters for Intermittent Catheterization (IC)

Intermittent catheterization is also called "in and out" catheterization. It is also called "clean intermittent catheterization" (CIC). Because it is clean you don't need gloves and sterile preparation.

A catheter is inserted in the urethra 3 to 5 times a day. After you empty your bladder, you remove the catheter and throw it away. You or a caretaker can insert the catheter. You don't have to wear it all the time. This lowers the chance of infection. And these devices don't have a balloon like the indwelling catheter.

Older men and women can perform CIC and should be on a routine schedule. The amount of urine in the bladder should be 15 ounces or less. Catheterization may be needed four to five times a day. Most healthcare insurances and Medicare will pay for 4 catheters a day (120 a month).

Most IC catheters are straight. Some (called Coudé catheters) have a curved tip. It may be easier for a man to advance a curved tip past the prostate gland. Catheter lengths are 6 inches for women and 12 inches for men.

You can get catheters and other supplies, such as lubricant, packaged together. These packages are helpful if you need to use the catheter at work. Catheter supply companies deliver catheters and other supplies by mail.

Absorbent Products

Absorbent products such as pads and adult diapers are available for incontinence. There are many designs. Some pads or panty liners have adhesive strips that attach to underwear. There are also undergarments, adult briefs and protective underwear. There are guards and drip collection pouches for men.

These products all absorb urine leakage and they help protect the skin from urine accordingly, they keep urine from wetting clothing. Pads can be disposable or reusable.

Absorbent incontinence products are designed to absorb and hold urine. Feminine hygiene pads are designed to absorb blood, not urine. The advantage of using incontinence products is that the surface area is closest to the urethral opening, which is above the vaginal opening. The pads are super absorbent and they cause less skin irritation and fewer rashes. Reusable pads are made of cloth with a rayon or polyester core and helps urine absorb.

When choosing a product, consider ease of use. Consider whether you need to remove outer clothing to change the device. Also consider absorbency, the liner, and the materials. For example, outside coverings made of plastic may irritate skin. Cost is also a concern for many people.

Toilet Substitutes

Portable devices can be very helpful if you cannot get to a regular toilet. These devices include commode seats or bedside commodes. There are also bedpans and urinals.

A bedside commode is placed close to the bed. It is easy to use at night or on a floor of the house with no bathroom. When choosing a commode you should consider its height and weight, how easy it is to empty, seat type, and cost. A soft surface may be more comfortable.

There are also raised seats (toilet raisers) that can help you get up and down from a regular toilet on your own.

Bedpans are usually not very effective or comfortable. Special fracture pans can help if you are recovering from surgery and can't get out of bed.

Urinals (plastic jug-type devices) are useful if you cannot move easily. You urinate into these devices directly. They can help when restrooms are not accessible. They are also useful when traveling. And they are an option if you are confined to a bed or chair. Most urinals, such as the newer spill proof ones, are easier for men to use. Urinals for women are not as easy to use.

Skin Care Products

If you are using incontinence devices or products, you may need skin care. Over time, urine leakage can cause skin breakdown, rash and redness. Urine on your skin can lead to bacteria growth and infection.

Soaps, skin products, topical antimicrobials, cleansers and skin barrier products can all help if used properly. Frequent washing with soap and water can dry out your skin. Rinses or cleansers made to remove urine may be better for washing the skin around the urethra.

Disposable wipes or wash clothes rather than toilet tissue may help keep your skin healthy. Moisturizing creams, lotions or pastes keep the skin moist. They seal in or add moisture. Barrier products protect the skin from contact with moisture. They lower friction from absorbent incontinence products.

Overflow incontinence tends to occur when the bladder, like an overfull hot water bottle, has pressure put on it and the urine is forced out. This can be caused by neurological problems, which affect the bladder's ability to contract fully, or where urine is not able to come out easily due to a blockage and so pressure builds up. Overflow incontinence accounts for approximately 10-15% of all incontinence cases. In most of these cases, overflow incontinence is caused by an enlarged prostate. Men with enlarged prostates often complain of a urine stream that is very weak, difficulties or hesitation in starting to pass urine then difficulties stopping the dribble. This is known as terminal dribble (or after dribble). These men often leave a large volume of urine in their bladder even after going to the toilet, this may cause feelings of not fully emptying the bladder. Consequently they need to visit the toilet very frequently. Overflow incontinence presents as a continuous incontinence and without proper treatment the person will be damp all the time. This causes a person to experience social awkwardness, low self-esteem and can lead to loneliness or restricted social behaviour.

Overflow incontinence may affect your night-time rest, by waking you up numerous times overnight with the need to use the toilet. This is known as nocturia. A difficult to empty bladder may also cause bladder or kidney infections, because urine that stays in the bladder for long periods of time offers some bacteria a good environment to grow in.

However, with your doctor’s help and some guidance from Depend you can manage the condition. The following section on overflow incontinence discusses the causes and how to manage it.

Essentially, overflow incontinence is caused when your bladder is filled beyond its normal capability. This generally results in leakage from the bladder, which may occur anytime during the day or night. This over-filling can be caused by two factors. The first, by an outlet blockage usually seen with an enlarged prostate. The second underlying cause might be a weak or absent bladder contraction, caused by damage to the neurological system. Nerve damage may be caused by a variety of ailments including Spinal Cord Injury, Parkinson's, MS or Diabetes.

Certain medications – especially Anti-depressants, Anticholinergic agents, Calcium channel blockers, Antipsychotics and Opioids are all known to affect a person’s bladder contractions. For a more complete listing of these medications you may like to visit the Australian veterans page: The impact of commonly used medicines on urinary incontinence.

The most important aspect of this type of incontinence is a correct diagnosis. A common test done by doctors and continence nurses is an ultra sound of your bladder. Your urine may also be analysed to check for bladder infections or kidney stones. Often treatment depends on the diagnosis of the underlying cause. For example, if it’s a medication that’s causing your incontinence, treatment may be as simple as changing your current medication to another type of medication that does not affect the bladder contractions but still addresses your needs. When the root cause is not known or you simply want to lessen the severity of the syndrome, the following treatments are recommended:

• Bladder Scheduling: This entails going to the bathroom at certain times during the day so that your bladder never overfills.
• Double voiding: A few minutes after you first empty your bladder, try again to empty the remaining volume. Some people find getting up to wash their hands after the first void and then returning to the toilet a good practice technique.
• Pelvic Floor Exercises As mentioned above, bladder contraction weakness is a common cause of overflow incontinence. Pelvic floor exercises can strengthen the surrounding muscles and strengthen your ability to hold on till you get to the toilet.
• For instructions of how to do Pelvic floor exercises
• Incontinence surgery: Surgery is one of many options your doctors may offer you when your overflow is caused by an enlarged prostate that blocks your urine flow. Incontinence following this type of surgery is common but for most men it often resolves in about 12 months. The most important things to do during this recovery period is to do Pelvic floor exercises
• Incontinence medication: A group of medications called alpha-blockers have been found to be effective in reducing the symptoms of overflow incontinence. These medications work by relaxing the portion of your urinary tract allowing your urine to flow out more easily. Your doctor is the best person to talk to about the appropriateness of starting this type of medication.
• Intermittent self-catheterisation:is another commonly used management technique, especially for those people with a bladder that does not contract well because of neurological problems. Your Urologist or Continence Nurse Advisor are the best people to talk to about this option. They will be able to teach you how to self-catheterise and what products you should buy.
• Products: Depend has a great range of disposable absorbent products that will help you feeling clean and dry. These incontinence products: are designed to minimise the embarrassment and stress that incontinence can cause.

Many people refuse to acknowledge that they suffer from overflow incontinence and so forgo any treatment. However, seeing your doctor does not need to be a worrying experience. Incontinence is a common problem and treatments are available. Book a visit with your GP or Urologist, who can make a diagnosis and recommend a treatment plan. You may feel isolated whilst suffering from these unpleasant symptoms but friends and family can be supportive and considerate while you are going through this difficult time. With help from your doctor, your support network and Depend, you will be back to normal life in no time.

Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.

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