Dear Dr. Gott: I'm going to be 90 next February. I'm quite an active woman and eat mostly health foods. I feel great, except for having trouble with "holding my water". I've tried many pills, but none seem to work. Is there anything on the market that can help me? I have absolutely no control. I wear Depends, pads, rubber pants and am desperate. I would appreciate any advice.

Reply: Urinary incontinence is defined as the inability to control urine leaking from the bladder. This is a relatively common and embarrassing condition that can vary in intensity from person to person. There are a number of reasons for the condition to occur. I will discuss the most common forms. Stress incontinence is just as the name implies. When laughing, sneezing, coughing, getting up from a sitting position, or with the removal of the prostate, a weakened bladder can cause an involuntary discharge of urine. Urge incontinence can occur when standing or sitting, by hearing running water, drinking fluids and more. Or stroke, Parkinson's or other diseases may damage the nervous system. Unlike stress incontinence apparent with a full bladder, this overactive bladder activity can occur when the bladder isn't full. The condition may awaken a person several times during the middle of the night.

Functional incontinence often affects older adults because of physical or mental impairment. Arthritis, Parkinson's, stroke and Alzheimer's may prevent a person from rising from a chair fast enough to get to a bathroom. A person will be fully cognizant of the fact that he or she has to urinate but will fail to react in adequate time. This is often the case in a nursing-home setting.

The bladder must remain relaxed so it can expand to store urine. When full, the bladder sends a signal to the brain. Under the best of circumstances, a person can respond to that signal and prepare to alleviate the problem. When other issues come into play, incontinence can occur. There are a number of reasons why the condition might occur in an otherwise healthy person. Caffeine and all beverages containing alcohol act as diuretics, as can some medications, antidepressants and muscle relaxants. As such, they cause the bladder to fill faster and more frequently than normal. Urinary-tract infections can irritate the bladder and result in an increased urge to urinate. These harmless and temporary conditions can happen to anyone at almost any stage in life. Conditions that can lead to chronic incontinence include obstruction, hysterectomy, interstitial cystitis, bladder cancer or stones, prostatitis, an enlarged prostate, obesity, kidney and vascular disease. With the assistance of your primary-care physician or urologist, you need to determine the underlying cause of your incontinence. This may require a simple urine test or blood drawing, pelvic ultrasound, cystogram or cystoscopy. If you smoke, the habit should be discontinued. If hypertension is an issue, it should be treated. Because of your age, you are producing less estrogen than you did in the past. This action can cause the lining of the bladder and urethra to lose some of its ability to close, resulting in incontinence.

A simple modification might make a great deal of difference in your quality of life.