Three out of 10 people experience some form of incontinence, but you don’t hear much about it.

Many people need to urinate more frequently as they age and there isn’t a formula for determining when urinary symptoms merit treatment, the rule of thumb is that when they interfere with a person’s quality of life, it’s time to seek help.

As women age, they lose estrogen while muscles in the bladder and urethra weaken, however chronic conditions like diabetes, congestive heart failure, Parkinson’s disease and stroke also can affect bladder. Calcium deposits in the kidneys or bladder also can prevent it from emptying completely, leading to sudden urges to urinate or leakage.

Incontinence isn’t just a problem for older people and those who have other health problems, though. Serious runners may experience some leakage because the rhythmic pounding of exercise takes a toll on their pelvic floor muscles.  Some young women also develop incontinence during and after pregnancy. The uterus sits above the bladder and the weight of the baby presses on the bladder, so that between one-third and one-half of pregnant women experience some incontinence, the symptoms don’t always go away after the birth, because the weight of a baby strains the muscles of the pelvic floor, she said.

Incontinence can also run in families, different ethnic groups tend to have different problems.

Despite the fact that incontinence is common, many women are embarrassed to talk about it or assume it’s a normal part of aging. Many doctors either don’t think to ask about it or don’t have the time to work with patients on what’s causing the problem.

Most people can improve their symptoms, though.  About 50% of people with incontinence improve after behaviour modification and 46 to 78% may be helped by taking medication without behavioural changes. When the two tactics are combined, 93% of people improve, surgery and nerve stimulation remain as as alternatives if these don’t prove effective.

One of the first steps is for people to keep a “bladder diary” of what is eaten and drank, when they urinate normally and any leaks. With that information, people can be helped to modify their habits and train their bladder to urinate at the right time.

Caffeine and alcohol are diuretics and can worsen bladder control problems. Spicy food, citrus fruits, excessive consumption of milk or calcium supplements and artificial sweeteners also can irritate the bladder.

The idea is to help people improve their quality of life, instead of giving them rules they may not follow. For example, instead instead of drinking several cups of coffee in a morning, rather than give up coffee altogether it’s easier to reduce the amount of coffee drank, switch to decaffeinated coffee, alternate between coffee and water throughout the day or sip the coffee, so that it doesn’t flood the bladder.

Some people also benefit from pelvic floor exercises that strengthen the muscles around their bladder. Many women develop incontinence during menopause, but these exercises can help women recovering from childbirth and importantly prevent incontinence for those who want to have children in the future.