I am 27 and have a three-year-old daughter. Since her birth I have noticed that when I cough or laugh too hard I have a bit of urine leakage. I mentioned this to my doctor, and he said it was because I was a bit overweight and that as soon as I lost the weight the problem would go away. Well, I've been losing weight, but I haven't lost the wetting problem. My doctor insists that it's just going to take a bit more weight loss. Isn't there something else I can try? I'm still going to lose the weight, but in the meantime, I'm stuck feeling like I have to wear diapers.

Susie

Ah, the tolls of motherhood. As if sleepless nights weren't enough, we have to worry about buying diapers for us as well as for baby! Urinary incontinence is a not uncommon problem after pregnancy, especially after a vaginal delivery. The effects of a baby's head on the vagina (like a bowling ball squeezing through a tube sock!) can traumatize the tissues, cause nerve damage and tear muscles involved in maintaining continence.

If you're overweight, weight loss can certainly help reduce the stresses on the pelvic floor. Still, sometimes even skinny moms leak urine. Kegel exercises may be helpful. These exercises basically involve tightening and drawing the pelvic floor muscle upward; imagine stopping a stream of urine and you'll know exactly what muscle to tighten. Biofeedback or electrical stimulation may make Kegel exercises more effective. Sometimes, however, the bladder and urethra have dropped, so that the normal mechanisms that keep us dry no longer function. In this case, surgery may be the answer.

If you are not happy with your doctor's advice, seek a second opinion. If you can, you may wish to see a urogynecologist, a specialist in problems such as yours. There are effective treatments available. Your daughter, at age 3, is probably out of diapers or nearly so; you can be too!