Stop a weak bladder from ruling your life

One in four women suffer from incontinence. It's a nuisance and an embarrassment and yet hardly anyone talks about it Urinary incontinence is an occupational hazard for women. The aftermath of pregnancy can be quite a physical burden for some - weight gain, droopy breasts, a painful episiotomy scar and urinary incontinence. The latter is always on the horizon. One in four women get it and it's a nuisance, an embarrassment and hardly anyone talks about it. It's all down to damage of the pelvic floor muscles, which hold up the bladder and help to stop leakage, being stretched during pregnancy and the birth of the baby. Those stretched muscles may never regain their former tone, especially if a woman fails to do pelvic floor exercises. They are crucial in the six weeks after delivering a baby, if you want to avoid incontinence for the rest of your life. But pregnancy isn't the sole cause. After the menopause, lack of oestrogen weakens the exit valve from the bladder and it may leak if pressure inside the abdomen increases (coughing and sneezing). That's called stress incontinence. Post-menopause, the lining of the bladder may become unduly sensitive to the presence of any urine and try to empty itself - that's irritable bladder. Either of these two conditions is made worse by obesity. Fat will compete with the bladder for space, reducing its volume and increasing its internal pressure. Firstly, a urine infection must be ruled out or treated. An examination will reveal a bladder prolapse, which can be repaired surgically. The next step is referral for a bladder X-ray, a cystogram and EMG to trace the muscular contractions in the wall and exit valve by a bladder specialist. HRT can do much to restore pelvic floor strength after the menopause. For irritable bladder, there's bladder retraining and muscle relaxant drugs. Then there are the all-important pelvic floor exercises that can help incontinence whatever your age. First, contract them by stopping the flow several times while you're urinating, tensing for five seconds, relaxing for five seconds, then tensing them again. Next, tighten and relax the muscles 10 times, as quickly as you can so that they seem to flutter. Next, contract the muscles steadily as though you were trying to draw an object into your vagina. Gradually build up to 10 contractions, 10 times daily or more, spaced over several hours. Once you've mastered the technique, you can do them anywhere, lying down, standing, watching television, even at the till.