Loss of bladder control (urinary incontinence) can happen to anyone, but is more common in the elderly. An estimated three to six million Britons suffer some degree of incontinence. It is twice as common in women than in men - especially in those who have had children.
Incontinence means that either the muscles or nerves are not working properly to control your bladder. 'Stress incontinence' is where a small amount of urine leaks during physical activity; 'urge incontinence' is when the bladder empties completely.
Severe stress incontinence is usually treated surgically by colposuspension, where the bladder opening (neck) is stitched back into its normal position. Generally carried out under general anaesthesia with a hospital rest of a week, it can still take two or more months to recuperate fully.
Currently, Eli Lilly's Yentreve (duloxetine) is the only drug available for stress incontinence. Its long-term consequences are not yet known but, according to the package insert, side-effects include nausea, vomiting, itching, insomnia, increased sweating, low sex drive and inability to have an orgasm.
For urge incontinence, GPs often prescribe anticholinergics such as oxybutynin, tolterodine and propiverine to relax the bladder. These also come with a raft of serious side-effects, many affecting the heart. And they can make an overactive thyroid worse, and cause heat prostration and hiatal hernia in addition to dry mouth, constipation, blurred vision and drowsiness.
Treating incontinence early could spare you from major surgery or drugs. Some alternatives that your doctor may suggest are:
* bladder control training, using:
pelvic muscle (Kegel) exercises to strengthen the muscles that help you to hold urine in your bladder longer
biofeedback, where electronic devices inserted into the vagina or rectum can help you to become more aware of your body's signals. Biofeedback-assisted behavioural therapy significantly reduced incontinence compared with oxybutynin therapy (Urology, 2004; 63 [3 Suppl 1]: 58-64)
timed voiding and bladder training, where you keep a chart of urination and leaking to find a pattern. Once you learn that, you can plan to empty your bladder before you leak.
* a pessary, a small, tampon-like urethral plug. In a study of advanced pelvic organ prolapse, 62.5 per cent of patients continued to use pessaries and avoided surgery (Int Urogynecol J Pelvic Floor Dysfunct, 2005 May 10; e-pub ahead of print)
* absorbent pads and underclothing
* vaginal cones. These are cones that are held in the vagina for increasing periods of time, and help to strengthen the pelvic floor muscles.