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Q: I sometimes experience urinary leakage when I cough or laugh, but also if I wait too long to use the bathroom. It's not every day, so I would rather not take medication. What do you suggest?

A: You are describing the very common type of leakage known as mixed urinary incontinence — a combination of both stress incontinence and urge incontinence.

Stress incontinence occurs when the pelvic muscles beneath your bladder aren't strong enough. They cannot withstand a "stress" or pressure pushing on the bladder. Your pelvic muscles give way and cannot hold back all the urine in your bladder. As a result, urine can slip out when you cough, sneeze, laugh, lift or even make an awkward body movement.

In urge incontinence, the bladder becomes overly sensitive to stretching, even before it's full. The bladder muscles squeeze and push out some urine prematurely. That's why it's also called an overactive bladder.

Here are steps you can take that should help to reduce or possibly even prevent the episodes of incontinence.

—Kegel exercises work for all kinds of urinary incontinence. They strengthen the pelvic floor muscles, which are used to hold in urine. Kegels are done by repeatedly squeezing and relaxing the pelvic floor muscles. If you have trouble doing Kegels, or they don't seem to be working, a physical therapist can use techniques like biofeedback to help you find the right muscles to squeeze.

—Bladder training (urinating on a schedule) helps you learn to gradually increase the amount of urine you can comfortably hold. It's most helpful for overactive bladder. Bladder training retrains the way the brain and bladder interact to provide more bladder control.

—Lose weight if you need to. Extra weight puts extra pressure on the bladder and pelvic muscles.

—Increase your physical activity, which should include a combination of aerobic exercise and resistance training with weights or machines. Studies show that building muscle mass as well as becoming more fit can help prevent incontinence.

—Watch your fluid intake if possible. Drink just when you feel thirsty. Unless you have a medical reason to drink more, limit yourself to 48 to 64 ounces of total fluids per day. Also minimize bladder irritants like caffeine, alcohol, carbonated drinks, spicy foods, and citrus fruits and flavorings.

(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

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