Exploring the condition of Overflow Incontinence

Introduction

Urinary incontinence is a condition characterised by the disorders in the management of the urinary function in the human body. The Incontinence is characterised into many types which differ in the manifestation of the disorders in the performing the urinary function. Overflow incontinence has been identified as one of the types of incontinence. This condition is manifested through the inability to control urination, occasioning from the inability to completely empty the bladder resulting in the overflow of urine (Osman and Chapple, 2017). During the manifestation of the overflow incontinence, patients may feel that their bladder is empty, though this is not applicable to all the patients. The overflow incontinence has been linked with embarrassments in the manifestation of the condition among the patients. Additionally, studies have associated the lack of management of the bladder to the development of the bacteria, which can result in urinary tract infractions. You may or may not sense that your bladder is full. This study examines the diagnosis and treatment options for patients with overflow incontinence (Wilson, 2016). For those seeking more focused assistance, healthcare dissertation help can provide valuable insights into addressing these challenges.

Causes and epidemiology of Overflow Incontinence

Bearing in mind the embarrassment associated with the urinary incontinence, studies have sought to examine the causes of the condition. Studies conducted have established that urinary incontinence is more prevalent in men compared to women (O’Donnell 2015). The manifestation of this condition is associated with the enlarged prostate in men resulting in the inhibition of the flow of the urine from the bladder. However, studies have also identified other associated causes of urinary incontinence. The blockages of the urethra is one such cause of the urinary incontinence which may result from conditions such as tumours, urinary stones, swelling from an infection and scar tissue.

Weak bladder muscles is also another cause of urinary incontinence. The weakness in the muscles makes it difficult for the muscles to squeeze the bladder empty during urination (O’Donnell 2015). This has been pointed to result into deposits of the urine that then leaks out.

Diagnosis of Overflow Incontinence

The diagnosis of the condition is crucial in the positive identification of the condition and aid in determination of the appropriate medical interventions for the conditions. The health guidelines postulate that early diagnosis of the condition helps in the effective mitigation of the condition.

During the diagnosis, the medical practitioner can conduct physical examination to help in the identification of the signs of the urinary incontinence and the reports of the physical examination may enhance the detection of the medical conditions associated with the urinary incontinence and further assessments from the urologists helps in the detection and management of the condition (Aoki et al 2017). Different tests can be used in examining the condition and they have been portrayed to exhibit varying results based on their efficacy and performance.

To begin with, catheterization is a diagnosis method that can be used to identify urinal incontinence condition by the medical practitioner by reliance on the examination of the flow of the urine among the patients (Nambier et al 2018). During the examination of the urine, the circumstance where the bladder doesn’t completely empty is an indication of the condition. However, the efficacy of this test is questionable. The other diagnosis examination method that can be used is the bladder stress test in which the urinary incontinence can be identified through the situation where coughing results in loss of urine (Nambier et al 2018) Urinalysis is one of the most commonly applicable method is the diagnosis of the conditions associated with the urine and bladder functioning. Urinalysis is largely a laboratory based tests conducted by lab technicians that can be used to identify the urine functioning, and evidence of kidney stones (Aoki et al 2017)

The other diagnosis method that can be used on the examination and identification of the urine incontinence through the conduction of imaging tests enabling the practitioner to visualize the inner body parts of the bladder, ureters and kidneys which are the mostly affected parts of the urinary incontinence condition (Birkhard et al 2016). The procedure can also be reliably used in measuring how much urine remain in the bladder after emptying them. However, other studies have identified that neither urinalysis nor catheterization assessment methods can succinctly be used in the diagnosis of the urinary incontinence (Birkhard et al 2016). In this case, urodynamic testing has been identified to be more effective and can be used in cases where the tests from other diagnosis methods were largely not effective. This has been attributed to the ability of the urodynamic analysis to evaluate the contraction of the bladder, urine flow, bladder pressure, and leakage and nerve signals. In yet another examination, cystoscopy test can be applied in the diagnosis of the urinary incontinence condition. A cystoscopy diagnosis can be described as a CT scan that is conducted in order to examine the kidneys and bladder, a procedure in which a special solution is injected in the vein of the arms while an x-ray is conducted on the kidneys, ureters and bladder of the patients (O’Donnell 2015). The use of technology enhances the diagnosis precision in the identification of the condition.

Treatment of the urinary incontinence condition

Treatment is a crucial aspect in the management of diseases and medical conditions and efforts have been put in place to ensure that disease prevention and management programs are fully implemented to manage conditions such as urinary incontinence, a condition that has been associated with serious complications such as diabetes (Imamura et al 2015). Despite the wide range of the therapy that have been suggested to be used in the disease management, person-centred and holistically focused treatment methods have been identified to be more effective. In the analysis of the available therapeutic interventions for urinary incontinence condition

Overflow incontinence conditions requires to be managed through a combination of the approaches aimed at ensuring that the patient fully recovers from the condition. In this regard, therapeutic approach may often require a combination of efforts from multi-dynamic teams to ensure that patients receive focused and comprehensive care that ensures their management of the condition. Studies favouring a combination of approaches postulates that multiple approaches in healthcare avails necessary alternatives that can be used by the medical practitioners in the management of the condition (Chow et al 2019; Imamura et al 2015). For instance, following the diagnosis of overflow incontinence, the doctors may recommend the use of medication to manage the condition, however, during monitoring, if the doctors identify that medical interventions are not effectively managing the condition of the patient, adjustments of therapeutic approach can be applied. This include changing the medication or combining he medication with behavioural therapy. The second approach is even considered more effective since it tackles a wider array of the needs of the patient.

This section examined that available treatment options for overflow incontinence and can be used to manage the condition of the patient. However, the emphasis on the holistic therapeutic care will be applied throughout this analysis.

Behavioural therapy

This is an approach that has been suggested to manage the condition of overflow incontinence among the patients. The application of behavioural therapy has been identified by studies as a crucial aspect that involve the training of the patients to ensure that they are capable of managing their condition (Imamura et al 2015). The application of behavioural therapy in management of overflow incontinence condition has been identified to be capable of being applied in a wide range of environmental setting, with both during the hospital or at home environments (Imamura et al 2015).

Accordingly, there are vital elements of the behavioural therapy in the management of the condition and they are tailored at ensuring that the patients manage to control urine leaks from the bladder. According to the study conducted by Komesu et al (2018), behavioural therapy model can be applicable to patients whose incontinence condition isn’t severe and the patient, with training can be able to effectively manage their urine pattern and flow.

The application of behavioural therapy is aimed at training the patients to effectively delay the flow and urination urge to ensure that the patients are able to control their urination pattern thus minimizing the leaks of the urine (Komesu et al 2018). One of the main behavioural therapies that can be used to manage overflow incontinence is behavioural training, which aims at ensuring that the patient is able to delay their urination period from one session to the other, practically, the therapy may be designed in a such a way that the patient waits for 10 minutes before urinating following the urge to urinate. With time, the time can be increased up to and even beyond two hours (Komesu et al 2018)

Kegel exercises have been suggested as part of therapy that can be applied to manage the overflow incontinence condition. Studies have suggested that kegel exercise are targeted at the pelvic muscles and regular exercises help to strengthen the muscles allowing the patient to gain control over their urge to frequently urinate. The exercises are generally designed in the squeeze, hold then release pattern with timings that can be designed by the practitioners in a manner that will ensure that the exercise is effective. However, while the behavioural therapy and interventions cab be adopted and help in the control of the overflow incontinence, bearing in mind that the approach is generally natural, the effectiveness of the program depends as a sole intervention is quite limited. As the study by Chow et al (2019) points out, overflow incontinence is often accompanied by other medical conditions, and thus overreliance on behavioural approach only as mitigation measure may not be effective in the management of the condition.

However, other types of behavioural therapies for the management of overflow incontinence include double voiding and scheduled toilet trips. Food management has also been suggested as another therapy that can be used to manage the incontinences.

Products and medical devices

There are available products and devices that could be applied in the management of the overflow incontinences. The idea behind the use of these devices is to enhance the comfort of the patients using these products and some can be used to manage the overflows. However, just as there are a variety of medical devices, so tare their applicable and uses. Each of these medical devices have been designed to perform specific function in the control and management of overflow incontinences. There are most commonly used devices whose application has even been recommended and aided by medical experts. Adult undergarments have been designed to be used in the management of the overflow by absorbing urine leaks, the use of the undergarments enhances the comfort of the patient and boosts their confidence especially in the public (Nambier et al 2018). Another medical device that can be used in the management of the flow of the urine among the patients with incontinences. A catheter is a soft tube that can have been designed to use in the medical environment to insertions in the urethra and serves to drain the bladder of the patients (Aoki et al 2017). These devices have been identified to be applied for several times during the day. However, unlike the undergarments, the use of catheter is limited to the presence of medical assistance and may be difficult to be used in public conditions.

Another medical device, which was designed specifically for women patients is a pessary. This device is a vaginal ring that has been deigned to be inserted and worn during the entire day and is useful in holding the bladder in place thus preventing the leakages of the urine (Testa 2015). However, like other medical devices, wearing and removing the pessary may be difficult to patients, especially under little or no help from medical professionals. A urethral insert is a medical device designed in a disposable manner, similar to a tampon and is inserted in the urethra to stop leakages of the urine from the bladder. This device is recommended to be applied before performance of physical activity which usually initiates incontinence and the urethral insert is recommended to be removed before urination (William 2016).

In, line with the patient centred are which is recommended to be an effective approach to enhancing provision of care to the patients and provide a holistic approach for the management of the medical conditions, the use of medical devices cannot effectively be relied upon to guarantee effectiveness in the management of overflow incontinence. Additionally, these devices have some precautions that should be adhered to for the functioning of the devices among the patients and the advice of the medical practitioners should be sought before using the devices (William 2016). For instance, if the rings and other devices to be inserted in the body parts are used inappropriately, the patient may experience complications associated with the improper use of the devices.

Medication

Medication has been a resourceful tool in the management of overflow incontinences and has been used with the recommendations from the doctors who have prescribed the medications of the patients in order to manage overflow incontinences experienced by the patients. The doctors play a crucial role in the medication of the patients and depending with the type and severity of the overflow incontinences experienced by the patients, different medications can be accorded to the patients.

Testa (2015) identified that medications play crucial role in the disease management due to the presence of the active agents for fighting the disease, while some have the ability to reduce the pain experienced by the patients suffering from the medical condition. Nevertheless, there are a wide variety of the available medications that can be administered to the patients to manage and control the incontinences. Alpha blockers are medications that help to relax the muscle fibre in the prostate and the bladder neck muscles (Testa 2015). These medications help the bladder to empty more completely. Alpha blockers are a wider category of the medications and the common alpha blocker medicines include alfuzosin, tamsulosin, doxazosin, and terazosin

The other common group of medicines that can be used to manage the overflow incontinence condition are the anticholinergics. These groups of medicines are used to manage the condition by controlling and preventing bladder spasms. The common medicines that can be used to acts as anticholinergics include oxybutynin, tolterodine, darifenacin and solifenacin (Dumoulin et al 2018)

Mirabegron (Myrbetriq) is another medication that can be used in the management of the overflow incontinence conditions that acts by relaxing the bladder muscle. Upon the administration of the dosage of the medication, the medicine works by helping the bladder to hold more urine and during urination, the bladder is able to completely empty (Chow et Al 2019)

Topical estrogen is another medication that can be administered to female patients with overflow incontinence, the application of the low-dose topical oestrogen that is administered through the vaginal cream, ring or patch is used to aid in the rejuvenation of the tissues in the urethra and vaginal areas (Parker and Griebling 2015). However, the home use of this medication can be risky and may worsen the condition since without the aid of a qualified physician, the medication may be improperly used, resulting in the damages in the bladder (Parker and Griebling 2015).

Interventional therapies that may help with incontinence include:

Overflow incontinence condition can be managed through some intervention measures that can be used to control the condition. These therapies are much similar to the functioning of medical devices and may help in limiting the overflow incontinence. There are common intervention measures that can be applied to manage the patients with overflow incontinence. To begin with, bulking material injections is a synthetic material is injected into tissue surrounding the urethra. This material is the n used to make the urethra to be kept closed and thus reduce the leakages of the urine. However, this procedure is more ineffective compared to the more- invasive treatments such as surgical operations (Chow et al 2019).

Botulinum toxin type A (Botox) is another method that can be used in the management of the overflow incontinences. This type of intervention therapy is suitable for the patients with overactive bladder and thus, the injection is prescribed to patients following the ineffectiveness of the first line medication (Chow et al 2019).

Another intervention therapy among patients with overflow incontinence is the nerve therapy. This therapy is a form of a devices that resembles pacemakers which is implanted under the human skins resulting in the delivery of painless electrical pulses to the sacral nerves whish are involved in the bladder control (William 2016). This stimulation results in the control of the urge incontinence. This intervention is also crucial and is provided to patients whose previous intervention weren’t successful.

Surgical procedures

Surgeries are recommended medical procedures that involve invasive procedures that result in the placement and administration of the therapy to the patients in the incised area. Overflow incontinence disease management can benefit from surgical procedures that can be conducted when the patients do not respond to other medical, and behavioural therapies. This is achieved

through a number of surgical procedures:

Artificial urinary sphincter is a surgical procedure applicable to man where a small, fluid filled ring is surgically implanted around the bladder neck and helps to keep the urinary sphincter shut until where the urination is ready (Dumoulin et al 2018). In this case therefore, during urination, the patient presses a valve implanted under the skin causing the skin to deflate allowing urine to flow from the bladder.

Recommendations

The management of overflow incontinence is a crucial aspect of enhancing the quality of life of patients who are suffering from the disease. Various medical, behavioural and surgical treatment methods have been identified and adopted in the management of the condition. However, to enhance the holistic recovery of the patients, a holistic approach of care should be adopted which entail combining two or more therapies based on the patient’s needs.

Conclusion

Overflow continence present a significant challenge to the patients and health practitioner providing care to the patients. The assessment, diagnosis and treatment of the condition is dynamic and varies from one patient to the other. As has been discussed above, there are treatment methods that can be applied to manage overflow incontinence and care of the patients is crucial to the patients as well as the administration of patient-centred care for the patient.

References

Aoki, Y., Brown, H.W., Brubaker, L., Cornu, J.N., Daly, J.O. and Cartwright, R., 2017. Urinary incontinence in women. Nature Reviews Disease Primers, 3, p.17042.

Burkhard, F.C., Lucas, M.G., Berghmans, L.C., Bosch, J.L.H.R., Cruz, F. and Lemack, G.E., 2016. EAU guidelines on urinary incontinence. Arnhem, The Netherlands: European Association of Urology, p.88.

Chow, J., Estrada, C. and Dempsey, M.K., Children s Medical Center Corp, 2019. Pelvic Muscle Rehabilitation for Treating Urinary Incontinence. U.S. Patent Application 16/333,780.

Dumoulin, C., Cacciari, L.P. and Hay‐Smith, E.J.C., 2018. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, (10).

Imamura, M., Williams, K., Wells, M. and McGrother, C., 2015. Lifestyle interventions for the treatment of urinary incontinence in adults. Cochrane Database of Systematic Reviews, (12).

Komesu, Y.M., Amundsen, C.L., Richter, H.E., Erickson, S.W., Ackenbom, M.F., Andy, U.U., Sung, V.W., Albo, M., Gregory, W.T., Paraiso, M.F. and Wallace, D., 2018. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. American journal of obstetrics and gynecology, 218(1), pp.111-e1.

MacLachlan, L.S. and Rovner, E.S., 2015. New treatments for incontinence. Advances in chronic kidney disease, 22(4), pp.279-288.

Nambiar, A.K., Bosch, R., Cruz, F., Lemack, G.E., Thiruchelvam, N., Tubaro, A., Bedretdinova, D.A., Ambühl, D., Farag, F., Lombardo, R. and Schneider, M.P., 2018. EAU guidelines on assessment and nonsurgical management of urinary incontinence. European urology, 73(4), pp.596-609.

O'donnell, P.D., 2015. Surgical instrument for treating female urinary stress incontinence. U.S. Patent 9,173,730.

Osman, N.I. and Chapple, C.R., 2017. Urinary incontinence principles. Oxford Textbook of Urological Surgery, p.244.

Parker, W.P. and Griebling, T.L., 2015. Nonsurgical treatment of urinary incontinence in elderly women. Clinics in geriatric medicine, 31(4), pp.471-485.

Testa, A., 2015. Understanding Urinary Incontinence in Adults. Urologic nursing, 35(2).

Wilson, J.A., 2016. The Management of Urinary Incontinence. US Pharm, 41(9), pp.22-26.

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