"Every time I would sneeze or laugh, I would leak a little,"says Catherine Robinson, 66, a retired psychologist from San Diego. "I never knew when it was going to happen. It was unpredictable and embarrassing."
For other women who suffer from a different kind of urinary incontinence called urge incontinence or overactive bladder, the need to always be near a bathroom consumes their lives.
"When the urge would hit, I had about a half a minute, and sometimes not even that long, to find a toilet, or else it was too late and I'd wet myself. It was terrible," says 61-year-old Ann (who asked that her last name not be published), a retired sales manager from Oceanside, Calif. "I was afraid to go anywhere because I always had to be by a bathroom. I stopped going to church, I couldn't play cards with my friends, and traveling anywhere was out of the question."
Almost half of all women will experience incontinence during their lifetimes, according to the National Association for Continence, a public information and advocacy organization. More than 17 million Americans, 85 percent of them women, suffer from stress or urge incontinence or a combination of both conditions. (For men, the condition is usually experienced after prostate surgery).
And, if you think urinary incontinence is only a problem for great-grandma, think again. About a quarter of the women with incontinence are between 25 and 44 years old.
"A third of incontinent women don't tell their doctor about their problem," says Dr. Charles Nager, a urogynecologist at the University of California San Diego Medical Center. "The typical woman will self-treat and try to cover up the problem with pads and diapers, spending a huge amount of money on absorbent products."
Some women view incontinence as an inconvenience and just part of getting older. Because they don't believe anything can be done to help them, they simply endure the condition's effects.
"Incontinence isn't a disease that will kill somebody, it's a quality-of-life issue. It's embarrassing and can impact every bit of a woman's life," says Dr. Scott Simon, a urologist at Scripps Memorial Hospital in San Diego. "Women (with incontinence) may avoid sexual intimacy, it affects their job, they lose self-esteem, it limits their social interactions, they stay in their house; and it can lead to isolation and depression."
But, things are finally starting to change. Incontinence is now coming out of the closet - or bathroom - and many women are discovering it's not a life sentence.
TV commercials and magazine advertisements about medications for incontinence have gotten people talking, and doctors say that's a start.
With their doctors' help, both Catherine Robinson and Ann gained control of their incontinence. Through medication and diet changes (no more coffee, wine or cranberry juice), Ann's problem is now manageable, and she's resumed most of her activities.
Robinson underwent a 30-minute surgical procedure and says, "Immediately I was normal again. I don't think grown women should have to wear diapers. That's what I was trying to prevent, and I have with the surgery."
Urinary incontinence can be divided into two types: Stress incontinence and urge incontinence or overactive bladder.
Stress incontinence is the involuntary loss of urine during physical activities like jumping or running, or sudden movements such as sneezing or coughing. Often a problem for women in their 30s to 50s, it occurs because the urethral sphincter (the muscle that opens and closes the urethra, the tube by which urine exits your body) or the pelvic floor muscles have been weakened.
When the pelvic floor muscles can no longer support the bladder properly, the bladder drops downward and pushes against the vagina, preventing tightening of the muscles that ordinarily close off the urethra. Leakage can then occur when extra pressure is put on the bladder by coughing, sneezing, exercising, etc.
The weakening can be caused by vaginal childbirth, weight gain or other conditions that stretch the pelvic floor muscles. Young women involved in very strenuous activities such as basketball or gymnastics can also have stress incontinence.
The pelvic floor muscles can also weaken with age, particularly after menopause or a hysterectomy because the urethra and tissues thin out and weaken with the loss of estrogen, explains Lynne Beresford, a certified rehabilitation nurse at Sharp Memorial Hospital's Biofeedback for Continence program.
Ever since Jody Gibbens, 37, gave birth to her son four years ago, frolicking with her children wasn't as much fun as it used to be.
"I'd be jumping around with them and I'd noticed my pants were wet. It wasn't a lot (of urine), but just a little trickle. Just enough to get my undies damp," says the stay-at-home mother of three children from Alpine, Calif.
Her doctor referred her to Sharp Memorial Hospital's Biofeedback for Continence program in which she learned to do a series of Kegel exercises to strengthen her weakened pelvic floor muscles.
Performing several sets of the exercises at least twice a day hasn't completely remedied her problem, "but it's a lot better than what it was," she says. "It's just a matter of remembering to do the exercises every day."
URGE INCONTINENCE OR OVERACTIVE BLADDER
Urge incontinence usually results in a demand to urinate more frequently, with a shorter warning time before urination occurs. Some women have accidents. But, even those who can make it to the restroom in time have their lives disrupted by frequent trips - up to 20 or more times a day as opposed to the average of seven. And they can be up three to four times at night.
"With urge incontinence, there's the feeling that you've got to go right now or you'll wet your pants. There's a lot of stress (associated with) this because they're always worried they will leak while in public," Beresford says.
For overactive bladders, the problem is uncontrollable spasms in the bladder muscles.
This overactivity may be caused by irritation of the bladder, emotional stress or neurological conditions, such as Parkinson's disease, multiple sclerosis or stroke. Often, the cause is unknown.
"We're all born with an overactive bladder, but our brains learn to control it," Nager says. "Then, for whatever reasons, as we get older, some of us lose the ability for our brains to control the bladder again."
Although overactive bladder problems are often associated with advanced age, it's not always the case, says Simon, who has treated women as young as 18 for the condition.
Making dietary changes can often significantly help the problem and should be the first step in treatment. Most women notice an improvement after giving up bladder irritants, including caffeine, alcohol, cigarettes and citrus juices.
"There's no reason for women to just accept incontinence and say 'Oh, my grandmother had it, now I have it,'" says Beresford. "We now know that even grandmother didn't have to have incontinence."
Correspondent Beth Wood contributed to this story.