My urge for nightly toilet dashes are now out of control

I'm a 78-year-old woman and lately have been getting up three or four times in the night to use the toilet.

- Dr Rosemary Leonard

Q It is not too much of a problem but I've noticed that by the time I get there, I have leaked, even though I get up as soon as I need to go. Last night, as I made my way to the bathroom, I wet myself so much it just gushed out of me, which is rather disturbing. I don't have the same in the day although I do feel the need to go, but don't do much. What do you suggest?

A You have what is known medically as "urge incontinence" - a sudden need to pass urine, which you may not be able to control. There are several possible causes of this.

Firstly, you may have a urine infection. Though in younger women this often causes pain on passing urine, and a need to pass urine far more frequently during the day and night, in older women the symptoms can be more subtle, and limited to a sudden need to pass urine, sometimes with leakage.

Another thing to consider is whether you are taking any medicines that could be making you produce more urine, especially at night, such as diuretics (used to treat for heart conditions), and some medications used to treat high blood pressure and diabetes.

But the most common cause of urge incontinence is overactivity of the muscles in the bladder wall. Normally the bladder muscles are relaxed as the bladder gradually fills, and when it is about half full, you notice the need to pass urine.