Anna Albrecht was a fit 31-year-old mother of two when the Big Leak happened one day. "I was jumping rope at the gym when — splash! — I completely wet my pants," she recalls. "I was so embarrassed." So did Albrecht go to the doctor? "Not for seven years," she admits. "I just didn't jump rope."

The leaks have stopped, thanks to a class aimed at strengthening her pelvic floor — the hammock of muscles that supports the internal organs, including the bladder, bowels, and uterus. "It made a huge difference — I can jump rope or go out dancing and stay dry," says Albrecht, 47, of La Grange, IL.

Leaks, urinary pain, wild sprints to the ladies' room, and a purse packed with pads are a reality for millions of American women. Yet two out of three of us never tell our doctors, and those who do speak up have waited, on average, 6.5 years. Instead, we cross our legs with every sneeze, scope out the fastest route to the toilet at parties, and hope for the aisle seat at movies and on airplanes.

"Talking about it can be embarrassing," says urogynecologist Sharon Knight, M.D., at the University of California, San Francisco. "Or women think it's an inevitable consequence of childbearing and aging and that nothing can be done."

If that's you, here's the headline: Women's biggest urinary problems are all treatable. Often, easy solutions like exercises, weight loss, and a couple of new habits (goodbye, diet-cola refills!) work wonders. Even when the problem is stubborn, there are new, effective treatments. (Out: cranberry juice to treat bladder infections. In: behavioral therapy for "tiny bladder syndrome.")

If you've got annoying symptoms, read the scenarios below, then learn about the newest ways to fix the problem you're not talking about.


Scenario 1

You leak when you laugh, cough, sneeze, exercise, carry heavy stuff, or have sex.

DIAGNOSIS Stress incontinence

WHAT'S HAPPENING Pregnancy, childbirth, extra pounds, declining estrogen levels in perimenopause and menopause, and normal age-related muscle loss can all weaken pelvic-floor muscles, resulting in more pressure on your bladder and on your urethra — the tube that carries urine out of your bladder.

STAT It's the most common form of incontinence in women, affecting one in four from ages 25 through 44 and one in three from 45 through 64.

BEST FIXES Start with low-tech solutions, which significantly improve or even "cure" stress incontinence for most women:

WEIGHT LOSS Dropping pounds eases the pressure on your bladder and pelvic floor, says Kristene Whitmore, M.D., chair of urology and female pelvic medicine and reconstructive surgery at Drexel University College of Medicine in Philadelphia. "In one study, women who lost 17 pounds reduced leaking episodes nearly 50%." Even those who lost a mere three pounds were 28% drier.

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 least three-quarters of leaks. "If you isolate the right muscles and do the exercises daily, you'll start getting results in six to eight weeks," says Chicago-based pelvic-floor physical therapist Judith Florendo. (See )

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."

MIND-BODY THERAPIES Hypnotherapy with visualization techniques and mindfulness-based stress reduction are both showing promise for urge incontinence. In one small study, the hypnotherapy/mental-imagery approach helped cut the average number of urge episodes by at least half per week.

Anna Raisor, 56, who works in website technology for a large corporation, had mixed stress and urge incontinence that began in her 30s and kept her from meeting friends for dinner or taking her two children on outdoor adventures. "I went for help when it got so bad I couldn't get in the door after work without an accident," says Raisor, who lives in Oak Park, IL. "The training helped me learn to relax and hold it, even on the commuter train."

QUICK FLICKS Kegels also come in handy, says Florendo: "When you have the urge to go, doing a couple of fast squeezes — called 'quick flicks' — can calm the bladder."

STILL LEAKING? Try acupuncture. In one Oregon Health and Science University study of 85 women, just four weekly sessions reduced accidents 59%. And there are many medications — tolterodine (Detrol) and solifenacin (Vesicare) are well-known ones — your doctor may prescribe.


Scenario 3

Burning pain and frequent urges, plus cloudy urine and sometimes fever

DIAGNOSIS A urinary tract infection (UTI)








Scenario 4

Your urine stream is slow, stops and starts, or doesn't empty your bladder completely. You may also have pain during sex

DIAGNOSIS Pelvic-floor muscle dysfunction

WHAT'S HAPPENING Your pelvic-floor muscles are always tense. "With normal urination, the bladder muscle contracts while the urethra and pelvic-floor muscles relax," Dr. Knight explains. "If these muscles can't relax, you can have urinary problems."

STAT Experts aren't sure how widespread the problem is or what causes it, but they believe it may be what underlies pelvic pain for many women.

BEST FIXES Don't do Kegels on your own — they can further tighten muscles. These techniques can help:

PHYSICAL THERAPY A physical therapist may use biofeedback to teach you to relax these muscles, which helps about 75% of the time. She can also check for weakness or spasms in the muscles of your lower back and hips that can make your pelvic floor tense up. Ask your doctor for names of therapists who specialize in pelvic-floor disorders.

AT-HOME SOOTHING Breathing exercises, whole-body relaxation techniques, soaking in a warm bath, and heating pads or ice packs (as recommended by a doctor or trained physical therapist) can also help.

MEDICATIONS Your doctor may prescribe muscle relaxants and drugs that ease nerve pain, along with physical therapy.


Scenario 5

You have difficulty starting to urinate and/or can't completely empty your bladder. You may feel bulges in the wall of your vagina, as well as pressure, low-back pain, or pain during sex

DIAGNOSIS Pelvic-organ prolapse

WHAT'S HAPPENING Weakened muscles of the pelvic floor and stretched-out connective tissue give way so that your bladder, uterus, and/or rectum presses into the wall of the vagina. Having had pelvic surgeries or several vaginal births, carrying extra weight, and aging all raise risk.

STAT Three out of four women ultimately have at least some degree of pelvic-organ prolapse. Usually it's mild, but 11% will eventually need surgery.

BEST FIXES Kegels may keep mild prolapse from getting worse, Dr. Knight says. If you need more support and want to avoid surgery, a pessary can help. "About 80% of women with prolapse can successfully be fitted with a pessary," she adds.


1. Find the right muscles

To isolate your pelvic-floor muscles before exercising them: Contract the muscles you use to stop the passing of gas. You can also try to stop the flow of urine while you're on the toilet, but not as an exercise — you'll confuse the normal brain/bladder reflex system.

2. Exercise slowly and fast

You want to strengthen both fast-twitch and slow-twitch muscle fibers, so you won't leak when you sneeze and so you can go all day without a problem. The long hold: Relax your body as you tighten your pelvic-floor muscles; hold the squeeze for five to 10 seconds, then relax for five to 10 seconds. Repeat. Build up to holding the squeeze for a count of 10, and do 20 repeats. The quick flick: Do a fast, strong squeeze, then release. Relax for five to 10 seconds; repeat. Work up to 20 per day.

3. Change positions

If Kegels are difficult, start while lying down. Later do them seated, then standing. Eventually, do them in any position that makes you leak — such as when you go from sitting to standing — and at times that cue strong urges — when you wash your hands, for example.

4. Call in an expert

Not sure you're getting it? Find a physical therapist who specializes in women's health at womens (click on Our Patients for the therapist locator).

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