Millions of women experience a loss of bladder control, or urinary incontinence, in their lifetime. It's a common and often embarrassing problem that many patients don't bring up with their doctors—and when they do, it might be mentioned as a casual side note during a visit for more pressing medical issues.

Now, new guidelines from doctors at the University of Michigan Health System offer family physicians a step-by-step guide for the evaluation of urinary leakage, to prevent this quality-of-life issue from being ignored.

"I think a lot of physicians don't realize that this problem can be successfully treated without surgery or other major interventions, and there are some pretty simple things they can do in the office to make a big difference for a lot of women," says lead author Dr. Abigail Lowther, clinical lecturer in the UM Department of Family Medicine. "We hope to give primary-care providers a framework for how to evaluate and treat many different forms of incontinence without the need for referral to a specialist."

The article was published this month in the Journal of Family Practice.

Studies have found that 10 percent to 40 percent of women older than 18 years old are affected by urinary incontinence. Of those women over 50 years old, as many as 53 percent suffer from the condition, studies say. Childbirth, aging, and obesity are among the long list of causes.

Despite the prevalence of female incontinence, however, family physicians might not hear about the problem until well into a visit focused on separate health issues—and some doctors may not feel like they can help.

But the paper suggests three simple, immediate steps a physician can take to address the problem while keeping the appointment on track: Collecting a urine sample, asking the patient to keep a diary that charts fluid intake and urination, and scheduling a follow-up visit.

By the second visit, the physician will have more information for further evaluation and a management plan. High-yield questions also will classify the type of incontinence being experienced. Questions might include asking how worried patients are that coughing will lead to a leak, how quickly a patient needs to find a bathroom when her bladder is full, and whether washing hands or the sound of running water leads to leakage.

Urinary incontinence of all types can be a great disruption to daily activities, ranging from occasionally leaking urine after a cough or sneeze to having an urge so sudden that patients might not make it to the bathroom in time.

For some, bladder leakage may be a symptom of another underlying medical condition.

Lowther says some women don't broach the subject with doctors because they think loss of bladder control is a normal part of aging. But left untreated, it might get worse with time and lead to more restrictions, she says.

"We want to emphasize to women that this is not something they have to live with, that they should tell their primary care physicians about their symptoms," Lowther says.

He adds, "We also want to remind physicians that simple interventions can go a long way towards improving this problem for patients."