New guidelines recommend solutions that don’t require medication.

Illustration: Scott Leighton To perform a Kegel, squeeze the muscles you would use to start and stop urination or hold in a bowel movement. Hold the contraction for five seconds, then release. Try to do three sets of 10 Kegel exercises a day.

It may be funny to say you laughed so hard that you wet your pants. But there’s nothing funny about it for millions of people who leak urine when they laugh, cough, or sneeze. “People are embarrassed by the condition. And some live with it because they believe there’s nothing you can do about it,” says Dr. May Wakamatsu, director of female pelvic medicine and reconstructive surgery at Massachusetts General Hospital and co-editor of the Harvard Special Health Report Better Bladder
and Bowel Control.

Types of incontinence

Problems with bladder control are called urinary incontinence, and they fall into a few categories. The leakage with laughing and other pressure on the bladder is known as stress incontinence. For women, it’s often a byproduct of childbirth, which can stretch or damage the pelvic floor muscles and nerves.

That’s a little different from another common type of incontinence known as urge incontinence or overactive bladder. This condition is caused by unpredictable contractions of the muscle in the bladder wall that stem from something temporary (such as a bladder infection) or from a chronic condition (such as multiple sclerosis, Parkinson’s disease, stroke, or diabetes). Symptoms include frequent urination (eight or more times per day, and several times per night); an urgent need to urinate; urine leakage; and waking from sleep to urinate. Postmenopausal women tend to develop this condition, possibly because of age-related changes in the bladder lining and muscle.

There are other types of incontinence. For example, overflow incontinence occurs if something blocks urine from flowing normally (which affects primarily men with enlarged prostate glands, but also affects women).

Treatment

Fortunately, there’s plenty you can do to treat incontinence, and most solutions don’t require medication. In fact, the American College of Physicians has new guidelines urging doctors to first prescribe pill-free treatments for women—such as Kegel exercises, bladder training, and weight loss and exercise—before prescribing any medications. Pill-free treatments are also helpful for men.

“Studies have shown that these first-line interventions can be very effective. Approximately 70% of women will improve enough that they are satisfied with their bladder control. This does not mean that the women have perfect bladder control, but they can exercise and carry out daily activities without bothersome urinary incontinence,” says Dr. Wakamatsu.

If these approaches aren’t effective, the next step might be treatment with medication, surgery, or even an injection of botulinum toxin (Botox) to relax overactive bladder muscles.

You can also try these lifestyle changes:

• Watch your fluid intake. Drink only when you feel thirsty, and don’t exceed six to eight 8-ounce cups of fluid per day from all sources, including soup.

• Stop smoking (to reduce coughing and pressure on the bladder, among other well-documented benefits for heart and lung health).

• Minimize bladder irritants (caffeine, alcohol, carbonated drinks, spicy foods, and citrus).

But most importantly, seek your doctor’s help if you start having any issues with urinary incontinence.