A sign for a ladies room on a light blue wall.

It’s embarrassing and uncomfortable to leak urine when you sneeze, or to race to a bathroom only to experience an unexpected gush as soon as you unbutton your pants.

But more than half of adults 65 and older experience accidental urine leaks, according to the Centers for Disease Control and Prevention.

With stress incontinence, movement such as coughing, sneezing, or lifting puts pressure on the bladder, causing urine to leak.

With urge incontinence (sometimes called overactive bladder), the other main type, there’s a sudden, immediate urge to urinate.

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Both are more common as we get older. “As people age, there’s a natural weakening of pelvic and bladder muscles over time, especially among women who have had vaginal childbirths,” says Vannita Simma-Chiang, M.D., a urologist at the Icahn School of Medicine at Mount Sinai in New York City.

That doesn’t mean you have to live with the condition.

“People just assume some leakage as they get older is normal, but it’s not inevitable,” says Yul Ejnes, M.D., an internal medicine specialist at Coastal Medical in Cranstone, R.I., and a former chair of the American College of Physicians Board of Regents. “If it bothers you, there are things you can do to improve it.”

Try the following strategies. 

Tell Your Doctor

“It might seem embarrassing to talk about,” Ejnes says, “but it’s important providers know, so they can make sure it’s not due to another condition, such as type 2 diabetes or a neurological condition such as Parkinson’s.”

Your doctor will perform a physical exam, ask about your medical history, and try to pinpoint which type of incontinence you have. (For example, leaking urine after you cough or laugh is more likely stress incontinence.)

He or she should also check your medication to make sure none is worsening the problem, and test your urine for blood, which could signal a urinary tract infection.

Your next step will probably be to keep a diary for a few days, writing down when and how much fluid you drink, when you go to the bathroom and how much urine you produce, and when leaks occur.

Tweak Your Lifestyle

A few steps, along with a doctor’s treatment, may help ease incontinence.

Lose weight if you’re overweight. This can take pressure off your bladder, Simma-Chiang says.

Be savvy about fluids. Try small amounts at regular intervals throughout the day rather than a large amount all at once, which can overwhelm your bladder. Limit alcohol and coffee, which increase urine production.

Work on getting regular. If you’re chronically constipated, those “stuck” bowel movements can cause leaks by putting pressure on the bladder, says Carrie Pagliano, D.P.T., a spokesperson for the American Physical Therapy Association.

So get enough fiber. Women should get 25 grams per day; men, 38 grams. Talk to your doctor if this doesn’t help.

Try Nondrug Therapies

Instead of medication, the American Urological Association and the American College of Physicians recommend pelvic exercises and bladder training first.

Postmenopausal women who did both weekly for three months had a 75 percent reduction in urine leaks, according to a study published in 2016 in the journal Menopause.

Physical activity can help normalize weight, which reduces pressure on the bladder­. Many types, including brisk walking and yoga, appear to strengthen the pelvic floor muscles that help control the bladder’s actions.

Kegel exercises, which strengthen the muscles that control urination, are important for men and women, says Sandip Vasavada, M.D., director of the Cleveland Clinic’s Center for Female Pelvic Medicine and Reconstructive Surgery.

To do them, pretend you’re about to urinate, then tighten the muscles you would use to stop the urine flow. Hold for 3 seconds, then relax for a count of three. Work up to holding for 10 seconds at a time, with three daily sets of 10 to 15 repetitions.

If Kegels don’t help after several weeks, ask to be referred for pelvic floor physical therapy. Women who have this are about five times more likely to report full symptom relief, according to a 2018 review.

“We can watch them doing Kegels while we do an ultrasound to make sure they’re doing them correctly, and if they’re not, show them how,” Pagliano says.

Biofeedback, which shows you which muscles you’re using, can be useful.

A physical therapist can also work with you on bladder training, helping you to “teach” your bladder to hold more urine by going to the bathroom at specific intervals during the day and gradually increasing the time between trips.

For women with stress incontinence, a pessary, a reusable device worn in the vagina, can help support the bladder. Impressa, an over-the-counter pessarylike device, is also designed to reduce leaks.

Be Cautious About Meds

Several medications are approved for urge incontinence, including mirabegron (Myrbetriq), oxybutynin (Ditropan XL and generic), solifenacin (Vesicare), and tolterodine (Detrol and generic).

Consider them only if incontinence symptoms inter­fere with a good night’s sleep or make you feel uncomfortable about leaving home, Simma-Chiang says.

Most (except mirabegron) are anticholinergics, which have been linked to dry mouth, blurry vision, constipation, dizziness, and confusion and dementia in older adults.

A large analysis published in 2018 in The BMJ found that these types of drugs are associated with a higher dementia risk even 20 years after use.

Mirabegron can cause dry mouth, raise blood pressure, and hike the risk of urinary tract infections and constipation.

For men whose leaks are related to an enlarged prostate, tamsulosin (Flomax), finasteride (Proscar and generic), and dutasteride (Avodart and generic) make it easier to fully empty the bladder. Tamsulosin can cause dizziness and headache; the others could reduce sex drive.

Consider Other Options

If meds and nondrug therapies aren’t sufficient, there are other options, such as injections of botulinum toxin type A (Botox) into the bladder muscles. It’s very effective, but “about 5 percent of the time it can affect your ability to empty your bladder fully, so you may need a temporary catheter,” Vasavada says.

In sacral nerve stimulation, electrical impulses are sent to lower-back nerves that control bladder and pelvic floor muscles.

In tibial nerve stimulation, electrical impulses are sent from the tibial nerve to the spine, where it connects with nerves that help control the bladder.

Several surgical procedures are also available for stress incontinence. The most common is the urethral sling, where strips of synthetic mesh are implanted to support the urethra. It can be helpful but carries dangers, such as infection and worsening incontinence, and the risk of the mesh eroding.

Editor’s Note: This article also appeared in the March 2019 issue of Consumer Reports On Health.