"It happens when I cough or sneeze but I can’t be bothered. I just wear (name brand)," says the attractive middle-aged woman on television.

The commercial tells us not to worry; instead, just buy the product. It’s an easy answer, private, no trips to the doctor. However, what women really need to know is that more than 90 percent of all bladder leakage problems can be treated successfully, often without surgery. It is estimated that as many as 20 million Americans may experience some type of involuntary loss of bladder control.

A woman may experience a slight dampness in her under- garments or total wetness after a strong sneeze or cough. She may find that she is all right until she arrives home and rushes to the front door but fails to make it into the bathroom before losing bladder control. Or, she may find herself getting up to go to the toilet three or more times during the night. She may finish going to the bathroom and start to walk away and then need to sit back down again. A woman may experience some of these symptoms or any combination of them. What can she do?

The answer is not to rush out and buy costly products before talking to her doctor or consulting a urologist. The involuntary loss of urine is a symptom, a sign that something is not quite right. Women who have this condition face serious social and psychological effects including discomfort, embarrassment, loss of dignity and low self-esteem. Surveys indicate that on the average, women wait three years before discussing this with their physicians and many do not discuss their condition with anyone at all. Women should seek medical advice and learn about the different options that are available.

For women, incontinence often begins after childbirth or during menopause and becomes progressively worse if not treated. Treatment can include many conservative choices.

Doing pelvic muscle exercises, often called Kegel exercises, helps strengthen certain pelvic muscles that aid in bladder function and control. Biofeedback machines can help ensure that individuals isolate the right muscles.

A variety of medications can help with urgency and bladder control. All medications have side effects and can interact with other medications; some combinations even cause loss of bladder control. In addition, several medical devices are available to assist with bladder support and continence. Some devices hold up the bladder and provide needed reinforcement. Others literally "plug" the leak.

Let us not forget that what we eat and drink has an influence on how well our bodies function. Spicy foods, sodas and lack of fruits and raw vegetables are culprits to faulty functioning. Also, if we go to the toilet frequently to prevent problems, we may be inadvertently training our bladders to hold less than we need it to - for example, during the night.

It sounds very complicated but it is quite simple. Become a detective. See what common threads you have in your diet, exercise and bladder health. What are your signs and symptoms? What makes it better or worse? Instead of being led astray by advertisements, take the time to learn more about what can be done by visiting your doctor.

Edmond J. FitzGerald, M.D., is board certified in Urology. He and his associates, Dr. John Devine and Dr. John Knud-Hansen, are members of the consulting Medical Staff at Kent & Queen Anne’s Hospital.