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" Bladder problems: distressing, embarrassing and common.  Yet one US study found 60 per cent of women with urinary incontinence (UI) had never talked to their doctor about the problem. UI can be treated, so don&amp;#039;t put up with feeling miserable or ashamed.  Talk to your GP, who can put you in touch with a specialist continence nurse. As well as your GP, you can phone the Bladder and Bowel Foundation nurse helpline on 0845 345 0165 for details of your local NHS continence clinics. Making an appointment is the first step to resolving your problem. If you&amp;#039;re unsure about what to say or do, you&amp;#039;ll find the guidelines below helpful. Before the appointment  Few people relish the thought of discussing their toilet habits with a doctor. But unless you tell your doctor, she won&amp;#039;t know you have a problem and so can&amp;#039;t help. Doctors are used to dealing with bladder problems \u2013 plus many other problems of an intimate nature. Don&amp;#039;t let nerves stop you from taking the first step. The first time you discuss it is the hardest. The more you talk about it, the easier it will become. You may wish to drop your doctor a note before your appointment, explaining what your symptoms are and how they are affecting you. It&amp;#039;s also a good idea to write down any questions you have, so you remember to ask them on the day.   The appointment What to tell the doctor   Whether you&amp;#039;ve had any surgery. If you&amp;#039;ve a history of urinary infection. Menstrual, sexual or bowel function problems. History of childbirth. Symptoms you experience and when. If you need to use pads. What medicines you take.  &amp;#039;I&amp;#039;m having trouble controlling my bladder&amp;#039;, &amp;#039;I find I&amp;#039;m leaking urine&amp;#039; or &amp;#039;I have problems with my bladder&amp;#039; are all ways to raise the problem of urinary incontinence. Your doctor will then want to know some details about your medical history because they can affect diagnosis.  Have you had any surgery?  Surgery may have affected your pelvic floor or your sphincter, causing stress urinary incontinence (SUI). Do you have a history of urinary infection?  Some urinary tract infections, including cystitis, can affect the detrusor muscles in the wall of your bladder and cause urge urinary incontinence (UUI). Have you had any menstrual, sexual or bowel function problems?  These may be factors that have led to SUI or UUI. Have you had children?  Nerve damage during childbirth is a possible cause of SUI, and pregnancy can weaken the pelvic floor muscles. Your doctor will want to know what kind of birth(s) you had.   Did you have a long labour? Was the birth vaginal or Caesarean?  Did you need help delivering with forceps or ventouse (suction cap)? Did you need an episiotomy? Did you have any difficulty passing urine or any episodes of leaking after delivery?   Medicines  You need to tell your doctor what medicines you take \u2013 both prescription and those you buy over the counter at chemists. Some medication can cause stress or urge urinary incontinence, or make it worse. Your doctor may be able to change your medication to a different type that won&amp;#039;t have this effect.  Symptoms Your doctor will also want more details about your symptoms.  Do you leak when exercising? What about if you sneeze, cough or laugh? Do you need to rush to the toilet? How frequently do you need to go to the toilet? Do you wake at night to pass urine? Are you using continence protection such as special pads or pants?  Questions your doctor may ask you There are other questions your doctor may ask to help decide:  what type of urinary incontinence you have  what may have caused your UI  the best type of treatment to offer you.  Questions to identify UI type  Do you always make it to the toilet in time? Do you have to wait for the stream to start? Does your urine come out reasonably fast? Do you feel as if you empty your bladder? Do you have to strain or push? Do you ever get wet unexpectedly when you think you have finished passing urine? Have you started to pass urine very frequently? When did you start leaking? How often are you getting wet? How much leaks out \u2013 a few drops, enough to wet your clothes or more? How do you cope with leaks?  Questions to identify causes  Does it ever hurt or burn when you pass urine? Does your urine smell unpleasant? Do you ever see blood or &amp;#039;smokiness&amp;#039; in your urine? How many cups of liquid do you drink in a day? What type of drinks? What time of day or night to do you drink? Where is your toilet? Do you have any difficulties getting to it? Do you have any difficulties adjusting your clothes?  Keeping a bladder diary Your doctor may suggest keeping a bladder diary for a week (also called a voiding diary), or you may decide to keep a diary before your appointment.  The simplest form of diary is a tick chart against an hourly schedule, showing when you passed urine and when you were wet. A more detailed diary would show:  the time what happened, eg you went to the toilet or you didn&amp;#039;t make it in time how much urine you passed so you can work out your total for 24 hours, eg the average amount of urine you passed per visit and the largest amount of urine you passed at any one time  the type/quantity of drink you had (and when) any activity you did that caused you to leak.  Why is it useful?  A bladder diary shows how often you go to the toilet, which can help identify any pattern with UI. It can also show how much urine you pass, which indicates whether your bladder is overactive.  You will probably pass the biggest volume after you&amp;#039;ve been asleep. If you pass less than 50ml of urine, you may be making your problem worse by going &amp;#039;just in case&amp;#039;. A diary can identify possible triggers such as exercise, type of drink and quantity of drink \u2013 whether too much or not enough. This can show a pattern for both SUI and UUI. If you have urge urinary incontinence, the diary can also track the progress of a bladder retraining schedule. Ask for explanations  If you haven&amp;#039;t understood something, always ask your doctor to explain again.  Your doctor won&amp;#039;t be impatient or think you&amp;#039;re stupid. Consent After discussing your symptoms, your doctor may want to examine your vagina and back passage for medical conditions that can cause or contribute to urinary incontinence. In accordance with GMC guidelines, your doctor should ask you to give your consent before carrying out the examination and a chaperone can be provided. Other people also read: Urinary incontinence in women: when should you seek medical help? Stress urinary incontinence: here are some things that can weaken the pelvic floor. The bladder and how it works: where are the problems?  References American survey: Journal of Women&amp;#039;s Health 2003; 12:687\u201398.   Based on a text by Dr Dan Rutherford, GP  Last updated 15.03.2015 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/conditions/liver-kidney-and-urinary-system/a11631/asking-your-doctor-for-advice-about-urinary-incontinence/>