Overflow Incontinence

• Types of Overflow Incontinence
• Neurogenic Incontinence
• After-Dribble in Men

Types of Overflow Incontinence

Sometimes people find that they cannot stop their bladders from constantly dribbling, or continuing to dribble for some time after they have passed water. It is as if their bladders were like a constantly overflowing pan - hence the general name overflow incontinence. Early symptoms include a hesitant or slow stream of urine when you pass water.

There are in fact several causes of this sort of problem, usually involving some sort of obstruction to the ready outflow of urine from the bladder. They include:

1. narrowing of the bladder outlet (urethra)
2. constipation, so that the distended bowel obstructs the bladder outlet.
3. You should seek professional help if you suspect that your problem is (1) or (2).
4. nerve damage affecting the ability to expel urine - e.g., resulting from injury or a condition such as multiple sclerosis.
5. in men, enlargement of the prostate gland, especially after the age of 55
6. in men, after-dribble may be the result of a kink in the urethra, the effects of which can easily be overcome.

Neurogenic Incontinence

This term is used to refer to incontinence produced as a side-effect of a disease of the nervous system (such as spina bifida, multiple sclerosis or Parkinsonism) or a spinal injury or stroke. The right treatment in such cases needs to be individually assessed: you should consult your doctor and/or your continence specialist.

After Dribble

Few men admit to having this problem but a great many suffer from it and are often badly embarrassed by it. Men at all ages can be affected.

After-dribble means the loss of a few drops of urine after the main stream, when the bladder appears to be empty. The medical term for this condition is post micturition dribbling.

It usually happens just as the penis is being replaced and garments rearranged, and ends up with trousers getting wet and stained. Some men find that, despite waiting and shaking, it remains a problem.

What is happening is that the urethra (the tube leading from the bladder to the tip of the penis) is not being emptied completely by the muscle surrounding it.  A "sump" of urine pools at a low point in the urethra (see diagram).

There are two proven ways of dealing with this problem. One is to perform pelvic floor exercises.

The other is to push the last few drops of urine from the urethra with the fingers before the final shake.

The technique is as follows:

• After passing urine, wait for a few seconds to allow the bladder to empty.
• Place the fingertips of the left hand three finger-breadths behind the scrotum and apply gentle pressure.
• Keeping the pressure in the midline, gently but positively draw the fingers forwards towards the base of the penis under the scrotum.
• This pushes the urine forward into the penile urethra from where it can be emptied by shaking or squeezing in the usual way.
• Before leaving the toilet, repeat the manoeuvre twice to ensure that the urethra is completely empty.

This technique can be practised at home. When in public toilets it can be done discreetly, with a hand inside a trouser pocket. It only takes a few seconds and will avoid the problem of stained trousers.

If after-dribble is associated with other urinary problems, for example delay or difficulty in emptying the bladder , or frequency or urgency , please consult your doctor or continence advisor.