Eeeek! I’ve started to leak. What should I do?

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By By Dr. Judith Reichman

Q: Lately, I find myself running to the bathroom all the time. Sometimes I can barely hold it in and find myself leaking urine. What can I do?

A: Involuntary leakage of urine, or urinary incontinence, occurs to half of all women at some point in their lives.

There are several types of urinary incontinence:

  • If you have leakage that occurs with straining, sneezing, coughing, lifting or jumping — basically, anything that makes your abdominal muscles push down on your bladder — you have stress incontinence.
  • If you have a tremendous and uncontrollable need to urinate, resulting in leakage, you have urge incontinence.
  • If you have both, you have mixed incontinence.
  • If you have a continual dribble, and can’t manage to completely empty your bladder when you urinate, you may have overflow incontinence.

Women are more likely than men to develop stress incontinence. The female urethra — the passage between the bladder and the outside of the body — is only an inch long, and any changes in this short conduit can result in a lack of urinary control.

The urethra should be at an angle that is slightly elevated above the bladder — pointing up. Once this angle is lost, the urethra loses its ability to block the flow of urine from the bladder. For example, when you sneeze or do something that otherwise puts pressure on the bladder, the urethra is pushed down, the angle is changed and urine is free to flow out.

Abdominal and pelvic muscle contractions can also affect the urethra’s angle. As a result, some women lose urine during intercourse. (However, lack of intercourse does not, despite some anecdotal reports, weaken the muscles involved and contribute to incontinence.)

The urethra’s blocking action must also be supported by two other mechanisms — an internal sphincter muscle and external pelvic muscles. Anything that weakens these will tend to produce unintentional loss of urine.

Risk factorsThere are certain risk factors for urinary incontinence. It occurs more often as a result of childbirth and age, both of which can loosen pelvic support.

Stress incontinence after childbirth is more likely to occur with a large baby or traumatic vaginal delivery. In some women, pregnancy itself can weaken the pelvic muscles. There is also a genetic component. Obesity, surgery, smoking, certain medications and overabundant fluid intake can worsen the stress on your bladder.

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What to doThough urinary incontinence is prevalent, many women are embarrassed to talk to their doctors about this. What’s more, they often cope by using minipads and sanitary napkins (which are designed to absorb blood, not urine). The average woman waits eight years before seeing help for this problem. You should broach the subject of bladder control — don't wait for your doctor to ask during a routine visit.

Meanwhile, keep a diary to help you pinpoint the problem. You can see an example at www.incontinence.org/diagnosis/bladdiary.html

Record the type and amount of fluid you drink, when you urinate, when you leak and whether leakage occurred when you had an urge to go.

You can also try some behavior modification techniques. Don’t let your bladder get too full — if you ignore it and let this happen, it will protest by contracting.

If you consume a lot of liquids, you should cut back. The idea of drinking huge amounts of water to hydrate yourself has little medical basis. Drink when you are thirsty, but don’t cut back so far that your urine is very concentrated. Avoid caffeine, spicy foods, alcohol, sugar, artificial sweeteners and chocolate if these seem to cause urgency.

Set up a bathroom schedule and stick to it, whether or not you have to go. Start by voiding every 1-1/2 hours. If you feel a sense of urgency, try to breathe through it. Increase the time between your bathroom visits by 15 minutes every few days until you reach a reasonable 3-hour schedule.

You can also try toning the pelvic muscles, which may let you gain more control over urination. Practice stopping or slowing the urinary stream at least once a day.

The well-known Kegel exercises, which have became famous for enhancing sex, were actually designed to aid women with incontinence problems. They help some women gain better bladder control when done properly. Contract the pelvic muscles or 10 seconds and then relax them for 10 seconds. Do these reps 15 times, three times a day. Don’t make the common mistake of tensing your buttock or abdominal muscles instead of your pelvic muscles. You are doing this wrong if you bounce up and down while “Kegeling.” (To check that you are tensing the right muscles you can initially insert a finger in your vagina. When you contract the muscles, you will feel it with your finger.)

Available medicationsIf your chief complaint is urge incontinence (also called overactive bladder), your doctor can prescribe medications designed to relax the bladder muscle by blocking receptors to certain neurotransmitters. The most commonly prescribed medications are oxybutynin fluoride, available as a pill or patch, or tolterodine, available as a pill.

The major drawbacks, which have been somewhat diminished by slow-release formulations and the patch, are dry mouth, constipation, headache and gastric upset. It may take up to eight weeks for these drugs to have an effect.

A new approach being used by some urologists: a local injection of Botox given in the urethral area to temporarily reduce activity of nearby muscles. This treatment has yet to be approved by the FDA.

In menopausal women who are not on hormone therapy, local vaginal estrogen may be helpful in reestablishing better blood supply, mucosal thickness and muscle tone in the vagina and urethra.

Surgery will not relieve urge incontinence, but can help stress incontinence. There are multiple procedures available. Some require abdominal incisions, and others can be done through the vagina. Before you have surgery, thorough testing should be done by a urologist or urogynecologist , who can outline the options and success and failure rates of each procedure.

Dr. Reichman's Bottom Line: If you have urinary incontinence, you needn’t suffer in shame or silence. If simple self-help techniques don’t give you more control over your bladder, see your doctor.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.