DEAR DOCTOR K:

I'm a middle-aged woman with urinary incontinence. Is there any way to treat this problem without drugs or surgery?

DEAR READER:

I'm glad you asked. Surveys of women across the country indicate that millions have urinary incontinence -- the inability to keep from sometimes leaking urine.

The reason I'm glad you asked is that those same surveys indicate that more than half the women with this problem never seek care for it. That's a shame, because there is much that can be done to fix it. There are several strategies you can try before considering medications or surgery.

Start with bladder retraining. This is a program of urinating on schedule. It helps you to gradually increase the amount of urine you can comfortably hold.

To begin bladder retraining, first keep track for a day or two of the times of day you urinate or leak urine. Calculate how long, on average, you wait between bathroom visits during the day, and then add 15 minutes. For example, suppose you calculate that you go to the bathroom about once every hour. Adding 15 minutes brings you to 1 hour and 15 minutes.

When you start training, empty your bladder first thing in the morning and not again until the interval you've set -- 1 hour and 15 minutes. You may feel uncomfortable as the end of that first hour approaches. However, do your best to hold off urinating until 1 hour and 15 minutes have elapsed. Keep up that practice: Wait another hour and 15 minutes before you urinate again. Each time you do this, you should feel that it is a little easier.

Once you're comfortable for the whole hour and 15 minutes, then increase the interval by 15 minutes. Again, it may take a while, but you'll get comfortable with the longer interval. Once you are, push out the time between urinations again by another 15 minutes. And so on. Over time, you should be able to wait much longer.

I also recommend drinking less fluid. For some people, this is all it takes to bring incontinence under control. (But don't hesitate to drink water if you are thirsty because you're hot or you've exercised.)

Pelvic floor exercises may also help. These exercises, also called Kegels, strengthen the pelvic floor muscles that help maintain continence.

To perform a Kegel, pretend to tighten your vagina around a tampon. You should feel the contraction more in the back than the front. Practice both short contractions and releases (lasting 1 to 2 seconds) and longer ones. Gradually increase the strength of the contraction and hold it at your maximum tightness for up to 10 seconds.

You can use these exercises strategically. Tighten your pelvic floor muscles just before coughing, laughing or whatever usually causes urine leakage.

We have more information on incontinence in our Special Health Report, "Better Bowel and Bladder Control." You can find out more about it at my website.

Many of my patients are able to treat their urinary incontinence with just these simple measures. I'll bet you can, too.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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