Rochester, Minnesota - If you're one of the many women who experience bladder control problems, don't let embarrassment keep you from getting the help you need. Leaking urine, having to urinate frequently and experiencing other symptoms of urinary incontinence aren't trivial consequences of childbirth or a natural part of aging.

Not all doctors routinely ask about urinary function during an exam. It's up to you to take the first step. If you have bladder control problems, tell your doctor about them and ask for help.

Why to seek help

Bladder control problems require medical attention for several reasons. Reduced bladder control may:

• Cause you to restrict your physical activities
• Lead you to withdraw from social interactions
• Increase risk of falling if you have balance problems and rush to the bathroom to avoid leaking urine

Sometimes having a bladder control problem means you may have a serious underlying medical condition, such as diabetes or kidney disease.

When to seek help

A few isolated incidents of urinary incontinence don't necessarily require medical attention. And most people, as they age, have to get up to urinate at night. But if the problem affects your quality of life, consider having your symptoms evaluated.

Make an appointment with your primary care provider if:

• You're embarrassed by urine leakage, and you avoid important activities because of it
• You often feel urgency to urinate and rush to a bathroom, but sometimes don't make it in time
• You often feel the need to urinate, but you're unable to pass urine
• You notice that your urine stream is getting progressively weaker, or you feel as if you can't empty your bladder well

Most of the time, symptoms can be improved.

When to seek a specialist

Many health care providers can evaluate bladder control problems without referring you to a specialist. In spite of better understanding and treatment of urinary incontinence, some providers may consider it an inevitable consequence of childbearing, menopause or aging. Others may lack the time, training or experience that make them likely to consider you for evaluation or treatment.

If your doctor dismisses symptoms that have an impact on your quality of life, or if the treatments he or she prescribes fail, ask for referral to a specialist. Doctors who specialize in urinary disorders include:

• Geriatrician. This medical doctor specializes in the care of older adults, often with emphasis on problems related to common quality-of-life issues, such as urinary incontinence.
• Urogynecologist. This is an obstetrician-gynecologist with additional training in problems that affect the pelvic floor — the network of muscles, ligaments, connective tissue and nerves that helps support and control the bladder and other pelvic organs.
• Urologist. A urologist specializes in male and female urinary disorders, as well as the male reproductive system.

Bladder diary: A detailed symptom record

Before your visit, ask your doctor's office for a bladder diary and how to use it so that you can track information for several days in a row.

A bladder diary is a detailed, day-to-day record of your symptoms and other information related to your urinary habits. It can help you and your doctor determine the causes of bladder control problems and the most effective treatments.

To figure out how much urine you pass, you can use any collection device that allows you to measure ounces or milliliters.

Medical history review

Your visit will be more productive if you provide a good medical history. Make a list of:

• Any surgeries, childbirths, illnesses, injuries and medical procedures, along with approximate dates
• Current health problems, such as diabetes or any condition that affects your ability to walk or rise rapidly to a standing position
• Past and current problems with your urinary system
• Medications you're taking, including each drug's brand or generic name, dosage, when you take it, and what you take it for

Medications can be associated with bladder control problems, so list everything — prescriptions, over-the-counter drugs, vitamins, minerals, herbs and other supplements. If you're not sure whether something counts as a medication, put it on the list.

What to expect from treatment

As a first step, your doctor may recommend lifestyle changes to "train" your bladder, such as performing pelvic-strengthening exercises (Kegel exercises) and following a schedule for when you drink fluids and use the bathroom.

For some women, medications help. For others, surgery provides effect treatment. But, both medications and surgery have side effects you'll want to discuss with your doctor before deciding on these treatment options. What's best for you depends on the type and severity of your bladder control problem.

Your bladder control problems may significantly improve after treatment. Any improvement, however, counts as a success, as long as it helps you to do what you like and enhances your quality of life.