Consult your doctor if you are unable to make a diagnosis from this chart.

Possible cause You may have an irritable bladder, in which there is a strong urge to pass urine even when the bladder contains little urine. Consult your doctor.

Action Your doctor will examine you and test your urine to rule out an infection, which can cause similar symptoms. He or she may also arrange for bladder function tests (see Urodynamic studies, opposite). In most cases, drug treatment to reduce the sensitivity of the bladder combined with exercises to increase the amount of urine that the bladder can hold without triggering the urge to pass urine will help to improve the symptoms.

Possible cause and action You may have an obstruction to the outflow of the bladder, which is preventing the bladder from emptying normally. This causes the bladder to become overfull and results in urine leaking from the bladder. Constipation is a possible cause of the obstruction. Consult your doctor, who will probably arrange for tests to determine the underlying cause. He or she may refer you to hospital so that your bladder can be drained and for treatment of the blockage.

Possible cause A decline in mental function with increasing age is associated with bladder control problems in certain circumstances. Consult your doctor.

Action Your doctor will examine you and may arrange for tests to exclude other causes. He or she may refer you to a trained continence adviser, who can advise you on ways of coping with the problem.

0 Absent periods

Menstruation normally starts between the ages of 11 and 14, although in girls who are below average height and/or weight it may not start until some time later. Once periods start, they may be irregular for the first few years and may not settle down to a regular monthly cycle until the late teens. Once the menstrual cycle is established, it varies in length among individual women from as little as 24 days between periods to about 35 days. Absence of periods

(amenorrhoea) may occur in healthy women for several reasons, the most common of which is pregnancy. Other factors that may affect your monthly cycle include illness, stress, and strenuous physical activity. It is normal for periods to cease permanently as you approach middle age. Only rarely is absence of periods a sign of an underlying disorder. Consult this chart if you have never had a period, or if your period is more than 2 weeks late.

Have you recently given birth, and are you breast-feeding?

Have you had sexual intercourse within the last 2 months?

Do any of the following apply?

• You are under stress

• There has recently been a major change in your life

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