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Most people attain bladder control by the age of two and stop soiling themselves or wetting the bed except on rare occasions. Some people (particularly boys) may take a few years more. A return of these childhood symptoms with dribbling of urine, inability to control the urge to go to the bathroom, urgent evacuation of urine when the toilet is sighted, (not necessarily after reaching it) or a total loss of control while coughing, laughing, sneezing or having sex, can be acutely embarrassing.
Urine is formed as a continuous process in the kidney. It passes down two pipes called ureters and reaches the bladder. From there it passes out through a short pipe called the urethra. The outflow is controlled by a sphincter under voluntary control. It relaxes to release urine only when the brain signals it to do so. This occurs when the bladder is full, and the area (toilet) socially acceptable. The bladder can hold 350-500ml of urine when it is full.
The sphincter may be weak and give way involuntarily, causing small amounts of urine to leak out, especially if the bladder is full. This situation is commoner in women. After vaginal childbirth, the pelvic muscles around the urethra may become weak. The birth process itself can cause injury. The vagina may be lax and the bladder and rectum may prolapse into it. Weight gain also increases the abdominal pressure on the bladder. In these conditions coughing, sneezing or even laughing vigorously may cause an accident.
A stone, tumour or some other obstruction in the bladder neck can prevent free flow of urine. Constipation causes hard motion stuck in the rectum to press against the bladder, preventing free urine flow, causing overflow, incontinence and even dribbling.
Men have a gland called the prostrate at the neck of the urethra, which can enlarge after the age of 40. This is usually non-cancerous and called “benign prostatic hypertrophy” (BPH). If untreated, it can eventually cause obstruction and dribbling. The prostrate can also enlarge due to cancer.
The bladder may be “irritable” — there is an urge to empty it even if a little urine gathers. Sleep is disturbed as the person has to get up to pass urine. This can occur because of urinary tract infection, stress, or a central nervous system disorder such as a stroke, Parkinson’s disease, or multiple sclerosis.
It is important to determine the cause of the urinary symptoms. A physician can usually make a diagnosis, with the help of the history, a general, pelvic and rectal examination and a few tests.
In women, pelvic floor muscles can be strengthened by doing Keegle’s exercises. This means tightening the pelvic muscles for 20 seconds several times a day. Also, when going to the toilet, do not pass all the urine immediately but try to control the flow by stopping and starting. Lean back while urinating, not forward. As long as the exercises are done the symptoms remain controlled.
An irritable bladder can be controlled by bio feedback. Note down the number of times you visit the toilet and the interval between visits. Consciously increase the interval. Also, restrict the quantity of fluid consumed to a minimum required — around 2-2.5 litres a day. Some groups of medications, such as anticholinergics and antidepressants, can be used along with these techniques for better results.
Train your bladder. Do not visit the loo until you simply have to. This will increase bladder capacity.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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