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Too Embarrassed To Tell Your Doc?

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SMARTER SIPPING Chugging multiple cups of coffee inflates your bladder like a ready-to-burst water balloon. Instead, sip water or herbal tea slowly, over a half hour or an hour, Dr. Whitmore suggests. Cut back on caffeine, carbonation, alcohol, artificial sweeteners, citrus, and tomato juice, all of which can irritate your bladder.

DAILY KEGELS For nearly half the women in a 2010 study, pelvic-floor-strengthening exercises helped a lot, stopping at lea)

STILL LEAKING? A specially fitted vaginal pessary, a rubber device somewhat like a contraceptive diaphragm, can lift your bladder and keep your urethra shut. Sling surgery uses a synthetic material to support the urethra in a position that reduces pressure. Another option: injections of a gel-like substance to thicken the wall of the urethra. Your M.D. can help you figure out which option is best for you.

Scenario 2

You have sudden urges to go — and can't always hold it

DIAGNOSIS Overactive bladder/urge incontinence (or "tiny bladder syndrome")

WHAT'S HAPPENING Your bladder is calling the shots instead of your brain. "As your bladder fills with urine, it decides when it wants to go — contracting even though the brain hasn't sent the signal," explains uro-gynecologist Shameem Abbasy, M.D., of Swedish Covenant Hospital in Chicago. Diuretic drugs, diabetes, nerve damage, and serious neurological conditions can cause this disconnect, though in most cases, no one knows why the condition develops.

STAT Some 17% of women have experienced the "gotta go now" symptoms of overactive bladder. A third of them also have stress incontinence.

BEST FIXES Try behavioral therapy strategies. For both overactive bladder and combo symptoms, they can improve or even resolve incontinence, say University of Minnesota researchers, who reviewed 99 studies:

A BLADDER DIARY Track when you went, what you were doing just before, and your food and drink intake for three days. Since urge incontinence is often tied to specific cues, a diary can help you uncover them. "You may discover you always have urges in the same situations, such as when you put the key in the front door or when you go from a warm environment to a cold one," says Michael Guralnick, M.D., associate professor of urology at the Medical College of Wisconsin. "You may find connections with drinking large amounts of fluid or with certain beverages. I've got plenty of sophisticated diagnostic equipment, but the bladder diary is one of the best tools for seeing patterns and finding solutions."

BLADDER RETRAINING You set times for bathroom breaks, then gradually increase the intervals between them. "The goal is to break your bladder's cycle of going whenever it feels like it," explains Dr. Guralnick. "By delaying for a few more minutes every few weeks, you're training it to hold more urine and to stay relaxed so you have time to walk to the bathroom."

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