Babies cannot control their urge to pass urine. As soon as the bladder fills up, signals are carried by nerves to the brain indicating that it is ready for voiding. This sets in motion cascading signals that lead to the bladder spontaneously empting. As the baby grows, these nerves mature, the brain becomes aware of a full bladder and can decide if it is an appropriate time to void. Urination comes under voluntary control. This usually occurs at the age of two. About 25 per cent of children can voluntarily control urination during the day by the age of two and 98 per cent by the age of three years. Girls achieve bladder control earlier than boys. Being able to control the bladder while sleeping takes longer and bedwetting can occur till the age of seven years.

Young adults have excellent bladder control. In women, pregnancy affects this as the uterus enlarges and presses on the bladder. Also, hormones secreted during pregnancy relax the pelvic muscles and this can make control difficult. Urination may become more frequent. Dribbling (stress incontinence) can occur while laughing, sneezing or coughing. It is aggravated by constipation.

Bladder control usually returns a year after childbirth although in some women stress incontinence continues. This is more likely if the birth was a vaginal one or if forceps were used. Stress incontinence is also common in women who are overweight or have diabetes.

Exercising the pelvic floor muscle should start during pregnancy and continue through life. Also known as Kegel exercises, these can be done while urinating or several times during the day. Just squeeze and contract the pelvic muscles and try to hold for 10 seconds. Do 1-2 second contractions 5-6 times when there is an urge to urinate.

An “overactive bladder” or “urge incontinence” is different from stress incontinence. The urge to empty the bladder becomes uncontrollable and the bathroom may not be reached on time. It can also occur in men, especially if there has been nerve damage after prostate surgery. Cystitis (bladder infection) or stones can also cause this. It can occur as a natural part of ageing, with diabetes, after a stroke or as a side effect of excess caffeine, alcohol and certain medications. In some cases, there can be a mixed problem with both stress and urge incontinence.

“Overflow incontinence” occurs when the bladder is full but cannot be not emptied. Urine dribbles out of the full bladder. It can be because of an enlarged prostate, tumours in the uterus, bladder stones or even constipation.

Uncontrolled urination and dribbling are socially embarrassing. They can lead to isolation. If the urine is in contact with clothes or skin, there can be a foul odour accompanying the person. The skin may become excoriated.

These problems are not a normal part of ageing and need to be tackled. A physician needs to be consulted. A routine urine examination should be done to ascertain if the symptoms are due to an infection. An ultrasound scan will show fibroids or an enlarged prostate. The post-void volume of urine should be checked to see if voiding is complete.

Treatable causes such as tumours and stones need to be tackled. Surgical correction of prolapse (in women) may be required. Weight loss, control of diabetes, avoiding caffeine, cigarettes, alcohol and doing regular pelvic exercises will help. While urinating, to correct the angulation between the bladder and urethra in women, lean backwards not forwards. It will ensure complete emptying of the bladder. Medications can be tried to reduce the size of the prostate and for an overactive bladder.

The writer is a paediatrician with a family practice at Vellore and the author of Staying Healthy in Modern India. If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in