Urinary incontinence can be an embarrassing problem, and many men and women who experience leakage try to ignore it or hope it will go away on its own.
But a bladder problem may be a sign of a more serious condition, and it can seriously impact your emotional health.
It's important to remember that you're not alone, and that there are health professionals and organizations that can help. Here are 14 resources that provide advice and assistance.
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Online bathroom finder
SitorSquat.com maintains a free database of public toilets around the world. In a pinch, it may help you locate a bathroom when you're in an unfamiliar place and suddenly experience the urge to urinate.
You can also download SitorSquat's mobile apps or use their SMS/text service to get results on your phone.
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Primary care physician
You may call your doctor at the slightest sign of a cold or flu. But if you're like two-thirds of people surveyed by the National Association for Continence (NAFC), you've never discussed bladder health with her.
Women live with urinary symptoms an average of 6.5 years before talking to a doctor. And men are even less likely to be diagnosed, says Nancy Muller, executive director of the NAFC.
Talk to your primary care provider. "They will have a sense of all the other medical conditions the individual has, and can start to guide the process," she says.
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Though your primary care doctor is a good place to start, women should also feel comfortable talking about bladder issues with a gynecologist. Leakage issues can occur during pregnancy or after childbirth, and a woman's ob/gyn is likely the doctor she sees most often during these times.
If your primary care doctor and gynecologist cannot diagnose or treat your bladder problem themselves, you may be referred to a urogynecologist, a doctor who specializes in women's bladders and incontinence.
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In older men, an enlarged prostate or prostate cancer surgery may cause incontinence. And younger men with unexplained leakage should see a urologist right away, says William Steers, MD, chair of the urology department at the University of Virginia School of Medicine, in Charlottesville.
"In this case, go right to a urologist," he says. "Do not pass go, do not collect $200. I think it's more cost effective to see a specialist, because you're not going to waste a lot of time and you'll get a diagnosis sooner."
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Gynecologic or urologic surgeon
Men and women with serious and prolonged incontinence may benefit from surgery. Talk to a surgeon to find out your optionssurgical and otherwise.
Beware of clinics that claim to have 100% success rates, and beware of advice from doctors who don't specialize in gynecology or urology, warns Bay Area urogynecologist and pelvic surgeon Tom Margolis, MD.
"Talk to someone who does this for a living," he says. "If my Mini Cooper breaks down, I'm going to take it to a Mini Cooper place, not a bicycle repair shop."
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Your doctor or pharmacist may recommend over-the-counter productssuch as pads, guards, and absorbent underwearthat can help you manage leakage problems.
Your pharmacist can also identify medications you're takingantihistamines, diuretics, or antidepressants, to name a fewthat could be contributing to your incontinence.
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Physical therapists who specialize in pelvic floor dysfunction can perform pelvic floor electrical stimulation and teach Kegel exercises, biofeedback, and behavioral techniques to improve incontinence symptoms. (These usually aren't the same physical therapists you'd see for, say, a sports injury.)
A 2011 study from the University of Alabama at Birmingham found that men who participated in four home sessions of behavioral therapyfluid management, pelvic exercises, and bladder control techniquesafter prostate surgery cut incontinence episodes by 55%.
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An occupational therapist may be part of your health-care team if your incontinence problems are caused by a disability or a neurological condition.
Parkinson's disease patients who are having trouble reaching the toilet, for example, may benefit from a home consultation on how to safely get to (and on and off) the toilet, says Nancy Muller, PhD, executive director of the National Association for Continence.
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If you have incontinence, it can contribute to depression, feelings of isolation, and low self-esteem. Dr. Steers says he's seen men with severe cases become almost suicidal.
A psychiatrist can help patients tackle the nonphysical aspects of the problem.
Some psychiatrists or psychotherapists can also help patients practice biofeedback and behavioral therapy, which may improve incontinence symptoms.
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Several studies have suggested that the traditional Chinese practice of acupuncture may reduce episodes of urge incontinence and frequency of urination in people with overactive bladder.
In a 2009 clinical trial, University of Pittsburgh researchers treated nine female incontinence patients with either true or "sham" acupuncture. Those who received the real thing reported an average 67% reduction in symptoms four weeks later, versus a 17% reduction in the placebo group.
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Diet doesn't usually play a huge role in incontinence issues, but paying attention to what and how you're eating may teach you more about how food and drink affect your symptoms.
It's a good idea to avoid caffeine and alcohol, and a higher-fiber diet is a plus. (Fiber reduces constipation, which can make bladder problems worse.)
A nutritionist or registered dietitian can provide suggestions for how to achieve these goals.
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You may feel less isolated if you join an incontinence support group; these often meet at hospitals or clinics. If you're not comfortable meeting in person, try an online message board.
Prostate cancer patients are strongly encouraged to use a support group, says Dr. Steers. They can be lifesavers after surgery, when depression is likely to hit.
"They were told they have cancer, then they have surgery, and now they may be left with, whoa, this totally debilitating incontinence," he says. "It's a huge social upheaval."
The organization's website contains sections in both English and Spanish for men, women, caregivers, and people with neurological disorders. It can also help you find an incontinence expert or clinical trial in your area.
If you or a loved one is suffering from incontinence on top of other health problems related to age or disability, a home health-care aid or placement in an assisted-living facility might make things easier for both patient and caregivers.
Home-care or visiting nurses often have training and experience caring for people with urinary problems; some may even be certified as nurse continence advisors, or NCAs. (North America's only university-based education program for NCAs is in Canada.)
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