Incontinence is sometimes temporary, caused by pregnancy, a urinary tract infection, a vaginal infection, constipation or some specific medications. But incontinence can also be caused by muscular problems, changes in the pelvic region after childbirth, a hormone imbalance, or a neurologic disorder.

There are three common ways to treat the problem. Teaching the patient behavioral techniques -- how to control the muscles of the bladder and the sphincter to prevent leakage -- sometimes works for urge incontinence. Kegel exercises, which work the pelvic muscles and are often assigned after the delivery of a child, can be effective for stress incontinence. Sometimes medication is prescribed to replace hormones, stop abnormal bladder muscle contractions or tighten sphincter muscles.

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Can childbirth cause urinary incontinence?

Q: Since my second child was born almost a year ago, I've had trouble with bladder control. I'm only 35 -- is something wrong?

A: Probably not. Most women have occasional urinary incontinence right after childbirth, most often when they sneeze, laugh, cough, or exercise, and about 10 percent to 30 percent have more long-lasting trouble with bladder control. That's because childbirth can involve some weakening or tearing of muscles and ligaments; and vaginal births sometimes result in temporary nerve damage. Second or third pregnancies seem to cause more trouble than first ones do. Many women find that the problem subsides by about six months after giving birth, but since you haven't seen much improvement in nearly a year, it's probably time to seek help.

Your obstetrician-gynecologist or health care provider should first do a physical exam. He or she should check to see that your bladder empties appropriately, that you don't have a urinary tract infection, and that you know how to contract your pelvic floor, or Kegel, muscles (the muscles that support the bladder, uterus, and vagina).

The next step is to strengthen those muscles with Kegel exercises: You can locate these muscles by practicing stopping and starting the flow of urine the next time you go to the bathroom. Then begin with a five-minute session once a day: Contract the muscles for a count of four; then relax them for a count of four. Since about one-third of patients do the exercises incorrectly, you should check with a nurse or doctor to make sure you're on the right track. You'll most likely begin to feel some improvement in your bladder control after about two months. In the meantime, try limiting alcohol and caffeine consumption, both of which may increase incontinence.

You may also want to try a kegel exercise device. It can't cure bladder problems, but it can aid in control. Two other options: The urethral plug and the urethral patch. These can be helpful for women who experience incontinence only in certain situations, such as while exercising.

When these measures don't help, some women opt for a surgical procedure called a urethropexy. It's successful for about 80 percent of patients, but you shouldn't consider surgery until you've tried less invasive treatments and are finished having children. If you find that your primary doctor can't help you, consult a uro-gynecologist or a urologist who specializes in female incontinence. Before seeing a specialist, make sure he or she specializes in nonsurgical as well as surgical treatment of incontinence.

The following specialists at the University of Iowa College of Medicine contributed to this column:

Christopher Arpey, M.D., assistant professor, dermatology, and associate director, dermatologic surgery; F. K. Chapler, M.D., professor, obstetrics and gynecology, and director, division of reproductive endocrinology and infertility; Samuel Kuperman, M.D., director of child psychiatry; Ingrid Nygaard, M.D., assistant professor, obstetrics and gynecology; and Phyllis Stumbo, R.D., nutritionist, Clinical Research Center