Clinical evaluation: History and physical examination
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Patients with overflow incontinence may present with constant dribbling, recurrent urinary infections, or renal insufficiency due to the presence of significantly elevated PVRs. In most instances, overflow incontinence is due to an underactive/acontractile detrusor or severe bladder outlet obstruction. Patients in the spinal shock phase of SCI will typically present with this pattern (due to an acontractile detrusor), which will often persist in those with lower lumbar and sacral cord injuries. Patients with continuous incontinence, which may be due to ureteral ectopy, fistula formation, bladder neck erosion (from long-term Foley catheter use), or occasionally a scarred, fixed urethra from multiple prior procedures, will report constant urinary drainage including at night while supine, often with very infrequent voids due to the lack of urine accumulation in the bladder.
Urinary Incontinence in Older Adults
K. Rao Poduri in Geriatric Rehabilitation, 2017
Overflow incontinence is caused by an atonic and over-distended bladder, urethral obstruction, or detrusor sphincter dyssynergia (DSD).9,29 It occurs when there is incomplete emptying of bladder during voiding effort or due to absent sensation of bladder fullness. The bladder fills to capacity, without the muscle contractions essential to result in a void.9 A void will only occur in the setting of OUI when urethral pressure is overcome by extremely elevated intravesical bladder pressure, resulting in the release of urine.9 DSD is seen with neurogenic bladder pathology, when the detrusor and urethral sphincter contract at the same time.29 Finally, in men, the most common cause of OUI is BPH causing urethral obstruction.9 Urinary dribbling, difficulty initiating void, weak stream, straining, and nocturia are often reported with overflow incontinence.1
Fluid balance and continence care
Barbara Smith, Linda Field in Nursing Care, 2019
Overflow incontinence (Table 6.5) is caused by an outflow obstruction such as benign prostatic hyperplasia in males, faecal impaction, or an atonic or hypotonic bladder. Sometimes referred to as: obstructive incontinence. Symptoms include: dribbling urine, feeling of bladder fullness, frequency, hesitancy, stop-and-start flow; susceptibility to urinary tract infections; leakage of urine is normally small and is associated with incomplete bladder emptying, resulting in urinary retention (Marjoram, 1999;Yates, 2018a); this accounts for less than 10 per cent of incontinence in older people. Contributing factors include the side effects of some medications, constipation and sudden immobility.
Economic analysis of Electrical Muscle Stimulator with Multipath technology for the treatment of stress urinary incontinence: a UK-based cost-utility analysis
Published in Journal of Medical Economics, 2020
Mehdi Javanbakht, Atefeh Mashayekhi, Ash Monga, Jowan Atkinson, Michael Branagan-Harris
There are various different types of UI, all of which are characterized by the involuntary leakage of urine. The most common forms are as follows: (1) Stress urinary incontinence (“SUI”) is the complaint of involuntary loss of urine on effort or physical exertion including sporting activities or on sneezing or coughing. (2) Urgency urinary incontinence (“UUI”) is involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to defer)5. (3) Functional incontinence, which exists when an individual is aware of the need to urinate, but for physical or mental reasons is unable to get to the bathroom. (4) Mixed urinary incontinence (MUI), which is the existence of both SUI and UUI together, and (5) Overflow incontinence is the complaint of UI in the symptomatic presence of an excessively (over-) full bladder. The prevalence of SUI alone steadily increases from 4.5% in 20–24 year olds to a peak prevalence of 18.2% at 45–49 years of age and then gradually falls to plateau at 10.9% from 60 years of age onward4, while approximately 40% of those patients that have UI are believed to be affected by SUI6.
High-intensity focused ultrasound therapy for pediatric and adolescent vulvar lichen sclerosus
Published in International Journal of Hyperthermia, 2022
Sili He, Jianfa Jiang
Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease, and its etiology is unclear and complex. It has a bimodal starting age, in prepubertal and postmenopausal age groups. There is a clear peak of incidence in girls aged four to six years old, which represents 7–15% of all VLS cases [1]. The main clinical manifestations are vulvar pruritus, irritation and pain, bleeding due to skin fissures and constipation [2,3]. Urinary tract symptoms, including dysuria, holding urine for fear of voiding and overflow incontinence may also be presenting features [4]. VLS has also been associated with a reduced quality of life among premenarchal girls. Since the symptoms of VLS can mimic other conditions, it is often initially misdiagnosed [5], and its diagnosis in girls is often delayed by an average of 1–2 years from the onset of symptoms to a final diagnosis. However, early diagnosis and treatment are crucial in improving symptoms and reducing the long-term sequelae of scarring.
Time to implement a national referral pathway for suspected cauda equina syndrome: review and outcome of 250 referrals
Published in British Journal of Neurosurgery, 2018
Muhammad Masood Hussain, Adam Alexander Razak, Syed Sibet Hassan, Kishor A. Choudhari, George Michael Spink
Once a diagnosis has been made of tCES, there still remains a lack of consensus regarding the timing of decompressive surgery. Meta-analysis of 322 patients by Ahn et al.3 concluded a significant advantage of treating patients within 48 hours. The study was criticised by Kohles et al.18 on statistical grounds for understating the value of early surgery. Todd,19 after reviewing 56 human and animal studies of CES concluded that all CES patients should have emergency imaging and emergency treatment to maximise the probability of a good outcome. However, others have argued the importance of identifying patients with reversible neurological impairment. The supposition is that those with urinary retention and overflow incontinence at presentation (CESr) already have an irreversible condition, whereby emergency surgery confers no outcome advantage. Studies20 have also expressed caution for out of hours surgery citing less than optimal conditions (tired, junior staff with non-specialist theatre scrub teams), which may add to rather than alleviate morbidity. Despite this lack of clarity amongst the medical profession regarding the timing of surgery, a study of medicolegal practice21 revealed that the majority of CES patients pursuing a legal course did not undergo emergency decompressive surgery, suggesting the courts and legal profession see no ambiguity.
Related Knowledge Centers
- Benign Prostatic Hyperplasia
- Bladder
- Bladder Outlet Obstruction
- Detrusor Muscle
- Urinary Incontinence
- Urination
- Urine
- Prostate Cancer
- Urethral Stricture
- Side Effect