Hi there,
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology.
You have written angina and migraine for which you are taking medicines. That is one of the several causes of Urinary Incontinence and should be looked into. Urinary incontinence isn't a disease, it's a symptom. It can be caused by everyday habits, underlying medical conditions or physical problems. A thorough evaluation by your doctor can help determine what's behind your incontinence.
Comprehensive list of causes of Urinary Incontinence:
1. Certain foods, drinks and medications can cause temporary urinary incontinence.
A simple change in habits can bring relief.
2. Alcohol. Alcohol acts as a bladder stimulant and a diuretic, which can cause an
urgent need to urinate. I do not think this could be cause in you.
3. Overhydration. Drinking a lot of fluids, especially in a short period of time,
increases the amount of urine your bladder has to deal with.
4. Caffeine. Caffeine is a diuretic and a bladder stimulant that can cause a sudden
need to urinate.
5. Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine
— artificial sweeteners, corn syrup, and foods and beverages that are high in
spice, sugar and acid, such as citrus and tomatoes, can aggravate your bladder.
6. Medications. Heart medications, blood pressure drugs, sedatives, muscle
relaxants and other medications may contribute to bladder control problems.
Easily treatable medical conditions also may be responsible for urinary incontinence.
7. Infections can irritate your bladder, causing you to have
strong urges to urinate. These urges may result in episodes of incontinence,
which may be your only warning sign of a urinary tract infection. Other possible
signs and symptoms include a burning sensation when you urinate and foul-
smelling urine.
8. Constipation. The rectum is located near the bladder and shares many of the
same nerves. Hard, compacted stool in your rectum causes these nerves to be
overactive and increase urinary frequency. In addition, compacted stool can
sometimes interfere with the emptying of the bladder, which may cause overflow
incontinence. Constipation can be side effect of drugs you are taking.

9. Pregnancy and childbirth. Pregnant women may experience stress incontinence
because of hormonal changes and the increased weight of an enlarging uterus.
In addition, the stress of a vaginal delivery can weaken muscles needed for
bladder control. The changes that occur during childbirth can also damage
bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic
floor. With prolapse, your bladder, uterus, rectum or small bowel can get pushed
down from the usual position and protrude into your vagina. Such protrusions
can be associated with incontinence.
10. Painful bladder syndrome (interstitial cystitis). This chronic condition causes
painful and frequent urination, and rarely, urinary incontinence.

There are several other causes like aging, hysterectomy, Prostatism, neurological disorder which are not applicable to you. The ten causes listed above you have to go back and analyse I feel majority are applicable to you.

Some changes you have made over last many years to recount the life style changes one must make to live with this conditions should the treatment fail:

Protecting your skin
Problems with urine leakage may require you to take extra care to prevent skin
irritation. Some things you can do to protect your skin include:
Use a washcloth to clean yourself.
Allow your skin to air dry.
Avoid frequent washing and douching because these can overwhelm your
body's natural defenses against bladder infections.

Consider using a barrier cream, such as petroleum jelly or cocoa butter, to
protect your skin from urine.
Making the toilet more convenient
If you have urge incontinence or nighttime incontinence:
1. Move any rugs or furniture you might trip over or collide with on the way to the
toilet.
2. Use a night light to illuminate your path and reduce your risk of falling.

I find from the list of drugs you have provided IMIGRAN is the only drug you are taking. Let me comprehensively revise for you the whole list of therapy, I am sure some of which you would have tried with the help of doctor and others you might like to undergo. The final call to take is between you and your urologist specialist.
Behavioral techniques
1. Behavioral techniques and lifestyle changes work well for certain types (and
less so for other types) of urinary incontinence. They may be the only
treatment you need.
2. Bladder training. Your doctor may recommend bladder training — alone or in
combination with other therapies — to control urge and other types of
incontinence. Bladder training involves learning to delay urination after you get
the urge to go. You may start by trying to hold off for 10 minutes every time
you feel an urge to urinate. The goal is to lengthen the time between trips to
the toilet until you're urinating every two to four hours.
Bladder training may also involve double voiding — urinating, then waiting a few
minutes and trying again. This exercise can help you learn to empty your bladder
more completely to avoid overflow incontinence. In addition, bladder training may
involve learning to control urges to urinate. When you feel the urge to urinate,
you're instructed to relax — breathe slowly and deeply — or to distract yourself
with an activity.
3. Scheduled toilet trips. This means timed urination — going to the toilet
according to the clock rather than waiting for the need to go. Following this
technique, you go to the toilet on a routine, planned basis — usually every two
to four hours.
4. Fluid and diet management. In some cases, you can simply modify your daily
habits to regain control of your bladder. You may need to cut back on or avoid
alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or
increasing physical activity are other lifestyle changes that can eliminate the
problem.

Physical therapy

Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles — the muscles that help control urination. Your doctor may recommend that you do these exercises frequently. They are especially effective for stress incontinence, but may also help urge incontinence.

To do pelvic floor muscle exercises (Kegel exercises), imagine that you're trying to stop your urine flow. Squeeze the muscles you would use to stop urinating and hold for a count of three and repeat.

With Kegel exercises, it can be difficult to know whether you're contracting the right muscles and in the right manner. In general, if you sense a pulling-up feeling when you squeeze, you're using the right muscles. Men may feel their penises pull in slightly toward their bodies. To double-check that you're contracting the right muscles, try the exercises in front of a mirror. Your abdominal, buttock or leg muscles shouldn't tighten if you're isolating the muscles of the pelvic floor.

If you're still not sure whether you're contracting the right muscles, ask your doctor for help. Your doctor may suggest you work with a physical therapist or try biofeedback techniques to help you identify and contract the right muscles. Your doctor may also suggest vaginal cones, which are weights that help women strengthen the pelvic floor.

Electrical stimulation. In this procedure, electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but it takes several months and multiple treatments to work.

Medications
Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:

Anticholinergics. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Several drugs fall under this category, including oxybutynin (Ditropan), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura). Possible side effects of these medications include dry mouth, constipation, blurred vision and flushing.
Topical estrogen. Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. This may reduce some of the symptoms of incontinence.
Imipramine. Imipramine (Tofranil) is a tricyclic antidepressant that may be used to treat mixed — urge and stress — incontinence.
Duloxetine. The antidepressant medication duloxetine (Cymbalta) is sometimes used to treat stress incontinence.

Medical devices
Several medical devices are available to help treat incontinence. They're designed specifically for women and include:
1. Urethral insert. This small tampon-like disposable device inserted into the
urethra acts as a plug to prevent leakage. It's usually used to prevent
incontinence during a specific activity, but it may be worn throughout the day.
Urethral inserts aren't meant to be worn 24 hours a day. They are available by
prescription and may work best for women who have predictable incontinence
during certain activities, such as playing tennis. The device is inserted before
the activity and removed before urination.
2. Pessary (PES-uh-re). Your doctor may prescribe a pessary — a stiff ring that
you insert into your vagina and wear all day. The device helps hold up your
bladder, which lies near the vagina, to prevent urine leakage. You need to
regularly remove the device to clean it. You may benefit from a pessary if you
have incontinence due to a dropped (prolapsed) bladder or uterus.

Interventional therapies
1. Bulking material injections. Bulking agents are materials, such as carbon-coated
zirconium beads (Durasphere), calcium hydroxylapatite (Coaptite) or
polydimethylsiloxane (Macroplastique), that are injected into tissue surrounding
the urethra. This helps keep the urethra closed and reduce urine leakage. The
procedure — usually done in a doctor's office — requires minimal anesthesia and
takes about five minutes. The downside is that repeat injections are usually
needed.
2. Botulinum toxin type A. Injections of onabotulinumtoxinA (Botox) into the
bladder muscle may benefit people who have an overactive bladder.
Researchers have found this to be a promising therapy, but the Food and Drug
Administration (FDA) has not yet approved this drug for incontinence, I am not
sure about Canada, your doctor would know). These injections may cause
urinary retention that's severe enough to require self-catheterization. In
addition, repeat injections are needed every six to nine months.
3. Nerve stimulators. Sacral nerve stimulators can help control your bladder
function. The device,which resembles a pacemaker, is implanted under the skin
in your buttock. A wire from the device is connected to a sacral nerve — an
important nerve in bladder control that runs from your lower spinal cord to your
bladder. Through the wire, the device emits painless electrical pulses that
stimulate the nerve and help control the bladder.
Surgery
If other treatments aren't working, several surgical procedures have been
developed to fix problems that cause urinary incontinence which include

1. Sling procedures.
2. Bladder neck suspension.
3. Artificial urinary sphincter.

Finally, you will have to have another appointment with your specialist and you discuss what could be best plan of treatment to follow. I have only provided the information gathered from various sources which I thought is relevant for you. If you have any further query, I shall be happy to answer. Hope this information is useful to you. If you write again please provide complete list of drugs you are taking try to spell the names of medical salt they contain or spell trade name correctly, so that I can be of help in suggesting that a particular medicine is contributory cause or the treatment of your problem.

With Best Wishes.

Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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