What is the initial management approach for overflow incontinence due to detrusor underactivity?

• A. Intermittent catheterization and addressing reversible causes
• B. Long-term indwelling catheterization
• C. Anticholinergic therapy
• D. Surgical reconstruction

Answer: (B)

When detrusor underactivity causes overflow, the bladder can’t generate enough contraction to empty properly, so urine backs up and leaks. The first priority is reliable bladder drainage to prevent high pressures, protect the kidneys, and control leakage. A long-term indwelling catheter provides continuous drainage, offering a straightforward, dependable solution for initial management when the goal is to prevent retention-related damage and reduce overflow symptoms. Anticholinergic therapy would worsen underactivity by further reducing bladder contractions, so it’s not appropriate. Surgical reconstruction targets problems like outlet obstruction or structural issues, not a poorly contracting detrusor, so it doesn’t address the underlying problem in this scenario. Intermittent catheterization can be used in many cases, but long-term indwelling drainage is often chosen first for its reliability and simplicity in managing chronic detrusor underactivity.