DEFINITION:

Leakage of urine associated with urinary retention.

PATHOPHYSIOLOGY:

• Bladder pressure exceeds urethral pressure and urine leaks.
• Bladder fails to properly empty due to over distention, pharmacological or neurological causes.
  • chronic over distension can stretch the bladder, reducing its ability to contract
  • drugs can inhibit bladder contraction allowing it to overfill
  • nerve damage from diabetes or lower spinal cord injury block nerve transmission
• More common in men than women
• In men, over distention may be due to chronic outlet obstruction from prostatic hyperplasia, prostatic carcinoma, or urethral stricture.
• In women, over distention may due to outlet obstruction from prolapse of the anterior vaginal wall (cystocele), prolapse of the posterior wall (rectocele), uterine prolapse, or complications following pelvic surgery.
• Fecal impaction can also lead to urinary outlet obstruction and chronic bladder distention

SIGNS & SYMPTOMS:

A large post void residual (PVR), and frequent or constant dribbling, and possible urgency and frequency of urination.

Instant Feedback:

With overflow incontinence, the bladder often remains quite full after voiding.

True
False

MANAGEMENT:

• Catheterization is to be avoided when possible
• Allow sufficient time for voiding.
• Instruct patient in double voiding
• Instruct patient in Crede's maneuver
• Review medications for anticholinergics and other meds which can worsen symptoms
• Alpha-adrenergic blockers including: doxazosin, prazosin, tamsulosin, and terazosin may be trialed to relax the musculature at the base of the urethra.
• Patient with abnormal PVR may require referral to urologist or gynecologist
• Patient teaching for intermittent or indwelling catheter as ordered
• Patients resistant to medical treatment may require surgery

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