Overflow Incontinence

1. Mechanism
   1. Bladder overdistention with Urinary Retention
   2. Usually have high residual urine
2. Etiology:
   1. Neurologic disease inhibiting detrussor activity
      1. Diabetes Mellitus
      2. Vitamin B12 Deficiency
      3. Herniated intervertebral disc
      4. Normal Pressure Hydrocephalus
   2. Bladder outlet obstruction
      1. Prostatic enlargement (Benign Prostatic Hypertrophy)
      2. Urethral or Bladder neck stricture
      3. Pelvic tumors
      4. Uninhibited Urethral sphicter contraction
3. Signs and Symptoms
   1. Palpable distended Bladder post voiding
   2. Post-void residual >200 cc (see Bladder Stress Test)
      1. Have patient void
      2. Insert Urinary Catheter and record urine volume
      3. Normally less than 50 cc
4. Diagnosis
   1. Ultrasound assess Bladder volume
   2. Uroflowmetry (urodynamics)
5. Management: General
   1. Correct underlying outflow obstruction
   2. Intermittent Self Catheterization
   3. Double Voiding
   4. Crede's Maneuver
6. Management: Betanachol (Urecholine)
   1. Mechanism
      1. Cholinergic agonist
      2. Parasympathetic stimulation contracts detrussor
   2. Indications: Non-obstructive Bladder atony
   3. Contraindications
      1. Hyperthyroidism
      2. Peptic Ulcer Disease
      3. Asthma
7. Management: Alpha-Adrenergic blockade
   1. Preparations
      1. Prazosin (Minipress)
      2. Terazosin (Hytrin)
   2. Mechanism
      1. Decreases Bladder neck and Urethral tone
   3. Indications
      1. Benign Prostatic Hypertrophy
      2. Sphincter Hyperspasticity (non-surgical candidate)