Incontinence: the facts

Do you always make sure that you know where the nearest loo is when you're out? Are you wary of sneezing or laughing too hard in case you ‘leak'? Many women can relate to these problems, but would never dream of describing themselves as incontinent.

The fact is, three million adults in the UK suffer from some form of incontinence, and as many as one in three of us will have a problem at some time in our adult lives. The good news, though, is that there are treatments, products and exercises that can help. Three-quarters of sufferers successfully manage their bladder weakness so it doesn't affect their lifestyle.

Why does it happen?
Stress incontinence is due to a weakness of the urethral sphincter or pelvic floor muscles, which causes urine to be leaked during everyday activities. The bladder is like a balloon filled with water, and the pelvic floor muscles seal it shut. If these are weak, pressure on the bladder can cause the seal to leak. Childbirth, pelvic surgery, the menopause, an oestrogen deficiency or a urinary infection can all trigger the problem. Danger times include:

Laughing, sneezing or coughing
Lifting a heavy object, exercise, sex or walking
Getting up from sitting or lying down

What can you do?

Techniques to improve pelvic floor muscles:
Do pelvic floor or Kegel exercises
To find out where your pelvic floor muscles are, pretend that you're on the loo and stopping urinating, mid-flow. The muscles that you use to do this are those that lift and squeeze the pelvic floor.

You can tone your pelvic floor muscles by regularly squeezing them for five seconds at a time, six times a minute. To begin with, it may be easier to do this when sitting or lying down. Gradually build this up until you can do the exercise six times a minute, for five minutes, three times a day. You should notice a difference between two weeks and three months.

Use vaginal cones and weights or pelvic floor toners
These are rubber or plastic eggs or cones that you insert in your vagina. While your body holds them in place, the pelvic floor muscles are given a workout. They're available from chemists, or order from beContent. Call 0870 7487979 for details.

Train your bladder
You can avoid leaks by retraining the muscles around your bladder. To do this, start by going to the loo every two hours, whether you need to or not, then gradually lengthen the time between visits by 15 minutes until you can wait for three hours. This will strengthen and tone the area.

Try using a Femetone
This is an electronic probe which you insert into your vagina. It sends out an electrical pulse to mimic the pelvic floor exercise and strengthen the muscles. It's available on the NHS and via mail order from Isis. Call 01942 238259 or visit www.isis-beauty.co.uk for more information.

Watch your diet
Don't think that reducing the amount you drink will help – keep your fluid intake up to at least 1.4 litres a day. Cranberry juice helps to avoid urinary infections, which can cause incontinence. However, some drinks can make the problem worse by producing excessive urine or irritating the bladder. Limit caffeinated and alcoholic drinks, and steer clear of tomato-based products and grapefruit juice. Constipation can contribute to the problem, too, so include plenty of high-fibre foods, such as fruit and vegetables, in your diet.

Complementary therapies
Consult a homeopath or herbalist, who may advise you to try the herbal remedy Horsetail (Equisetum) or Causticum, a homeopathic treatment.

Practical ways to cope with incontinence
There are many new pads and pants designed to cope with incontinence. Try Tena Lady (0845 3080 8030 or visit www.tenalady.co.uk) or Depend (freephone 0800 521128 or visit www.depend.com/uk). These both have products in a range of absorbencies, such as Poise Normal Pads available from pharmacies and large supermarkets.

Three surgical procedures to help with stress incontinence

TVT (Tension-free Vaginal Tape)
This new procedure involves a 30-minute operation, usually done under local anaesthetic. A piece of mesh is placed under the middle of the urethra to provide support when there's a risk of leaking. Success rates are high, with 90 per cent of women cured or significantly improved.

Colposuspension
A major operation, this requires a general anaesthetic and involves stitching the bladder neck to a ligament to lift it up and stop it leaking. It has a 50 to 70 per cent success rate.

Periurethral injection
This involves injecting a bulking agent, such as collagen, around the urethra and bladder neck to make the seal more watertight. This can be done with a local anaesthetic and takes 15 to 20 minutes. Eighty per cent of women are cured or have an improvement three months after the operation. However, the bulking agent can disperse and may need topping up.

Why else would I spring a leak?
In addition to stress incontinence, there are two other types of incontinence – overflow and urge.

Overflow incontinence feels as if you haven't completely emptied your bladder after using the loo. It may be caused by a blockage in the urethra (the tube leading from your bladder), which prevents the flow of urine, or neurological problems that leave the bladder partially full all the time. Ask your GP about anti-cholinergic drugs, which relax the bladder muscles, or operations that enlarge the bladder and weaken its contractions.

Urge incontinence means you urinate as soon as you feel you need the loo. It's caused by overactive bladder muscles, which contract to empty the bladder when it should store the urine. This can be due to nerve damage of the bladder or psychological reasons, such as anxiety.

Useful contacts:
The Bladder and Bowel Foundation: 0845 345 0165; www.bladderandbowel.org