Many people hesitate talking about bladder-control problems. But they shouldn't. Incontinence is surprisingly common, affecting more than half of women and 30 percent of men ages 65 and older, according to the Centers for Disease Control and Prevention.  

If you leak unexpectedly or sometimes have such a strong urge to urinate that you fear you won’t make it to a bathroom in time, you could use products such as absorbent pads or underwear. Or you might be considering a drug or procedure you’ve seen advertised.

But what works best? Our experts weigh in.

Start With Your Doctor

If you feel uncomfortable talking about the problem, consider that your primary care doctor has probably discussed it with many patients. (If he or she hasn’t treated bladder conditions, see a doctor who has, such as a gynecologist, urologist, or urogynecologist.) “A doctor can determine if a medication side effect or a condition like diabetes or a urinary-tract infection might be causing urine leakage,” says Consumer Reports’ chief medical adviser, Marvin M. Lipman, M.D. 

Try Non-Drug Therapy

Exercises or bladder training should be the first treatment tried, says the American College of Physicians. Kegel exercises (repeatedly tightening and relaxing the muscles that stop urine flow to strengthen them) are especially helpful for women with stress urinary incontinence, or leaking when they laugh, cough, sneeze, lift heavy objects, or exercise. Bladder training involves keeping a diary of urination and accidents, then slowly increasing the time between bathroom visits. It’s most effective for men and women with urge incontinence, a sudden, urgent need to urinate. Kegels haven’t been proved to be effective for men, but experts say trying them is reasonable. Women with both types of incontinence can try bladder training and Kegels.

Both strategies can help. A small study recently published in the journal Menopause found that a 12-week course of physical therapy, which included Kegels and bladder training, resulted in a 75 percent reduction in the number of leakage episodes, an improvement that was still evident a year later. Study subjects who didn’t do the physical therapy techniques saw no improvement, and a year later their incontinence had worsened. Using the correct muscles to do Kegel exercises is key to success, so don’t hesitate to ask your doctor for advice. And be patient; it can take several weeks to see a benefit. 

Know Drug Pros and Cons

Several drugs are approved for urge incontinence (or overactive bladder), such as prescription mirabegron (Myrbetriq), oxybutynin (Ditropan XL and generic), solifenacin (Vesicare), and tolterodine (Detrol and generic). The little evidence available suggests they might work as well as non-drug therapy. But according to our Best Buy Drugs experts, more than half of those who take incontinence drugs stop within six months because of side effects including constipation, drowsiness, dry mouth, blurry vision, and dizziness. Botulinum toxin type A (Botox) injections into the bladder muscle are also approved for this condition and may reduce the urge to urinate. But they have been associated with urinary-tract infections and incomplete bladder emptying requiring catheterization.

“Medications should only be considered for those who continue to have bothersome symptoms despite having tried lifestyle changes and therapy exercises,” says Michael Hochman, M.D., M.P.H., an assistant professor of clinical medicine at USC’s Keck School of Medicine. 

Think Twice About Surgery

Several surgical procedures are available for stress incontinence. The most common is midurethral-sling surgery, where strips of synthetic mesh are implanted to support the urethra. It can be effective. In a study of several hundred women published in the New England Journal of Medicine in 2013, 85 percent of those who had the surgery said they no longer leaked. Only 53 percent of those who did physical therapy alone got relief after a year.

But the surgery carries risks including infection, difficulty urinating, and an increase in the severity of incontinence. “Surgery should only be considered as a last resort,” Lipman says.