Q. I leak urine when coughing, sneezing, or getting up from a chair — it's so embarrassing! What can I do?

A. Your loss of urine on exertion — stress incontinence — occurs in 75 percent of incontinent adults.

If you have urge incontinence, you might urinate too often, or when you put your hands in water. Sometimes it happens so fast and out of the blue that you don't make it to the toilet in time, often causing falls and even hip fractures.

Forty percent of incontinent adults have both urge and stress incontinence. See your doctor for an exam.

Up to half of women (and a smaller percentage of men) have incontinence. It can cause isolation, depression and shame, which keeps about 50 percent of incontinent women from discussing the condition with a doctor. But talk, as there are effective treatments.

"It has taken the fear out of my daily life. I have gone from a feeling of helplessness to a feeling of encouragement. I no longer have the shame of accidents," said a 59-year-old after learning Kegel exercises at the Continence Program at Kaiser's Physical Therapy Department at Mapunapuna. The program taught her how to contract the right pelvic muscles to strengthen the sphincter, or valve, that stops urine from leaking out.

A typical "prescription" involves doing three to five sets of five to 15 contractions daily and it may take several months for improvement. It's not that easy — one study found a quarter of women doing Kegels were contracting the wrong muscles.

Therapist Cheri Teranishi-Hashimoto has folks watch a 15-minute educational video and her staff teaches participants about skin care, odor control and adsorbent products. Some learn about biofeedback, electrical stimulation or vaginal weights.

The best chance of cure for both urge and stress incontinence is by combining Kegels with bladder training, where you gradually increase the time between urination. The goal is to go every 3 to 4 hours. If the urge to urinate comes before "its time," just remain in place till the urge subsides. Cross your legs to help hold it in, or if you feel a cough or sneeze coming on, then move slowly to a bathroom. The senile may need to be reminded periodically to urinate, or have a commode or pan near the bed.

Losing weight helps, as do some medications. Oxybutynin and tolterodine help those with urge incontinence but may take two months for full benefit and can cause dry mouth, constipation, confusion and — with oxybutynin — hallucinations. Cymbalta (Duloxetine), which is used for pain and depression, can reduce but not cure stress incontinence. Its side effects include nausea, diarrhea, and in drinkers, possibly hepatitis.

Start with Kegels and bladder training — various physical therapy groups outside of Kaiser also teach these. Surgery is a good alternative for stress incontinence if other measures fail.

Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.