DD2009 - I can totally understand what you are going through. I've had this problem for most of my life and I'm now 62. As you say, sometimes I'm fine. I can sometimes go for a month or more without any problems. Then suddenly, I have an accident. Luckily it most frequently happens at night so I know from past experience that protection is necessary.
I've gone to all the Drs. and they haven't found anything profound. I have diabetes and neuropathy so whenever the Dr sees that, they just say it is caused by the diabetes and that is where it ends. I would really like an explanation, especially seeing that sometimes I have no problems at all. But when I do have problems, I have no feeling when it is time to go, it just happens. It is like the sphincter just opens. I have little or no sensation of fullness even when I'm OK. There is a small indication that I should go that disappears when I'm in my "wet cycle". But trying to get a Dr to investigate that is very hard. I have no idea what they would do to tell why that sensation goes away sometimes. I also have no idea why my sphincter works sometimes and sometimes it doesn't. Seems to me that I should get treated when I'm having problems rather than when I'm not but I've gone to 3 urologists and they seem more concerned about my erectal dysfunction than my incontinence. I like sex but I hate wetting my pants. Seems like there is a issue of surgery profits over some unknown nucience like incontinence, especially when it isn't all the time. I won't tell you what one Dr wanted to do to me but I ran out of the office and never went back.
I've accepted the likelihood that I'll never know why. I've also learned to always wear navy blue or black pants. That has saved my so many times. I have had accidents in public places including work and it is very depressing but luckily it is mostly a mental issue and not a public embarrassment. It is embarrassing but mostly the inconvenience rather than someone pointing out my predicament.
I hope you get some help. I'd definitely see a urologist and try to get the tests when you are having problems. It doesn't help when the plumbing is working. I did find out that my sphincter is mis-shapened but the Dr didn't seem to think that was the cause.
The other thing that I've learned is that the drs don't totally understand how everything works. I'm certain my problem is nerves but being an electronic engineer has taught me that sometimes circuits don't always work right, especially if there is a short somewhere. Imagine trying to find a short circuit in your body. I don't know if that analogy works but that's the way I look at it. Sometimes the circuit works, sometimes it doesn't. I've tried to figure out what triggers it without any success so I just try to deal with it as best as I can. One thing that is weird I guess is that I feel more confident when wearing a diaper than when I'm not but I do really like being continent otherwise it might be easy to just wear diapers all the time.
I've given up trying to see if a Dr will help me. I've probably gone to 6 or more different drs and nobody has any ideas other than live with it. My primary Dr asks how I'm doing and I tell her if it is getting worse. So far, I'm probably 65/35 dry/wet right now and I would not mind too much if it stays there. I've had periods when it was more like 50/50 or worse. So who knows? This has been going on for years and I've been able to keep my secret. My family knows and my in-laws know but beyond that, I've been able to keep stealthy enough so nobody else knows that I'm aware of.
It sure is fun
Dan