Urinary symptoms include urinary frequency, urgency, incontinence and retention. Gynecologists may also treat female urinary incontinence. Symptoms may include vaginal fullness, pain with sex, trouble urinating, urinary incontinence, and constipation. Urinary frequency, urge incontinence and nocturnal incontinence occur. The disease progresses to subcortical dementia associated with pseudobulbar palsy and urinary incontinence. Other may have trouble starting urination, urinary incontinence, or frequent urination. Reported side effects include diarrhea, abdominal pain, fever, hypoglycemia, urinary incontinence, and chest pain. Kegel exercises may be beneficial in treating urinary incontinence in both men and women. There can also be underlying medical reasons for urinary incontinence which are often treatable. In older children, new onset urinary incontinence (loss of bladder control) may occur. Alternative exercises have been studied for stress urinary incontinence in women. They also had some benefits, such as less urinary incontinence and less perineal pain. The most compelling contraindication is urinary incontinence and overall fluid retention. This contributes to the urinary incontinence seen with NPH. Duloxetine was approved for use of stress urinary incontinence (SUI) in the EU in 2004.