Incontinence: Troubled waters

It was years before Jacqueline Brown sought help for her incontinence. When she did, she found a complete cure. So why do millions of women still suffer in silence?

Victory! Finishing the annual charity fun-run was great, but it wasn't just a sporting triumph. For me, jogging for six miles with dry shorts was a very precious personal best. For the last two years I had been strenuously fighting stress incontinence sudden leaks of urine so perhaps I was a bit of a masochist to keep on taking part. But I knew that if I could do this run it would prove how much I had achieved and I had won.

Incontinence whiffs (excuse the pun) of old age, loss of control and nappy pads, yet sufferers range from young yummy mummies to 40 per cent of women over 40, according to a UK urinary study carried out in 2000 by the Medical Research Council. The Incontinence Foundation confirms that there are six million weak bladders in the UK, and one in three women leak when they laugh, cough, sneeze or lift heavy objects. In fact, the statistics are probably much higher, as many people, not surprisingly, won't admit they have a problem. I was one of those statistics, and my problem was kept strictly within the family.

Why don't we uncross our legs and rush for help? Quite simply, we cope and hope the problem will disappear. This was what I did. While I loved the idea of doing a fun-run, trying to hide the wetness wasn't so hilarious. Two extra-strength pantyliners couldn't contain the flow, which, despite squeezing tight (quite difficult while you are running), was like a constantly dripping tap. At the finish, I'd race to the loo with fresh knickers and talc before meeting friends in the pub. Already I'd given up aerobics, and tennis was inhibiting. Dancing and playing active games with the children caused problems, and increasingly I was dripping daily just from carrying heavy shopping or picking up children. Stress incontinence was blighting my life.

Stress incontinence is usually caused by the weakening of the pelvic-floor muscles (PFM) throughout pregnancy and childbirth, during which they take quite a beating. Stretching from front to back passage, these muscles act like a hammock supporting our waterworks, as well as the growing baby. It's interesting to note that while women's awareness of body care during the ante-natal period can verge on the obsessive, postnatally, it's a different story, where taking care of your body takes a low priority compared to embracing breastfeeding and a new routine. Most mothers recall leaving the maternity ward with a sheet of pelvic-floor exercises, following a brief chat with the physiotherapist. Breastfeeding aids the recovery of stomach and PFM elasticity, but some women never completely regain good tone. As menopause approaches, hormonal changes can further weaken the area.

It's a shame that more women don't seek help, because there are treatments out there. The first stop should be PFM physiotherapy, which brings about improvement in 85 per cent of women.

These days, a higher priority is given to this area of women's health, confirms Katie Jeitz, senior physiotherapist at the Whittington Hospital in London. "Pelvic-floor health is promoted from early pregnancy. On discharge, women are given a health pack and we run one-to-one appointments and classes in specific cases. Often, it's five or 10 years later, when incontinence starts to interfere with lifestyle, that women seek help. A GP can refer women to physiotherapy, and the earlier the better. Women still don't know enough about their pelvic floors. We have to get over the taboo, talk about it with our girlfriends"

Katie Jeitz estimates that around 20-30 per cent of her cases are young women, rising to 50 per cent of women approaching or in menopause.

Feeling guilty that I hadn't done my PFM exercises religiously, and worrying that I might be thought vain and that it was all too late, I put off wasting my GP's time. Yet as an active person, and with menopause looming, the fact of losing it "down there" was my spur, and I was referred to a private women's health physiotherapist, Mrs Ola Lawal. Before this, I'd been ignorant of the existence of such specialist physios, as I suspect most women are. She swept away my nervousness and explained the importance of re-educating my bladder.

"Stress incontinence is partly due to weakness of the pelvic-floor muscles. These support the pelvic organs, bladder, uterus and rectum, and there is a high chance of developing vagina prolapse, when any or all could start to down, because the muscles become too weak. People can suffer for years, due to embarrassment or assuming they have to live with it."

Determination strengthened, if not yet my pelvic floor, I first learnt to locate the muscles by squeezing tightly as if trying to stop peeing and passing wind at the same time. An internal examination decided that I was not prolapse material but my pelvic floor was weak. Next was the insertion of a periform probe linked to an EMG (electromyographic) bio-feedback machine, which measures and monitors muscle tone by emitting tingling electro pulses that wake up the muscles. Ola Lawal explains: "Apart from weakness, the reason people can't exercise the PFM well is because they have reduced sensation. If you can't feel what you are doing, you can't do it, and if you feel you can't do something, it becomes a chore and motivation lessens."

During the first of many weeks of treatment, I went home with an exercise regime to perform, complete with attached "stick", which would wave up and down between my legs (causing hilarity in the bedroom) as muscle tone increased. It was really no chore: I wove PF exercises into my daily routine, from sitting at traffic lights in the car to standing in supermarket queues. And there's an added bonus to achieving a toned PF with increased sensation: the sexual plus that comes with it.

Months later, my leaks had reduced dramatically and I felt fitter. My year-later check with Ola Lawal showed further improved muscle tone, but I was disappointed that, after many months of work, I could not stay completely dry during high-impact exercise. Although many women would be content with the success I had achieved, I was expecting more. I did not want to compromise my sport and I wanted to avoid degeneration during menopause. Ola suggested a last option: an operation to insert a TVT (tension-free vaginal tape). This improves the bladder neck angle, one of the things we need for continence.

Back to the GP for another referral, this time to consultant obstetrician and clinical director of Women's Health at the Whittington, Mr Clive Spence-Jones. A specialist in urogynaecology (NHS and private), he is passionate on the subject of leaky waterworks.

The TVT was developed in Scandinavia. The operation involves making a small cut above the vagina and threading in a mesh underneath to support the urethra. The needle's exit and entry is via the lower abdomen. Having performed over 300 TVT operations, Spence-Jones explained the reasons for surgery.

The first step, and it was not a comfortable one, was to pass the indignities of a 30-minute plus urodynamic test, during which small tubes (catheters) are gently threaded up your front and back passages. These are slowly filled with fluid while a computer, attached to a specially adapted lavatory, measures how much your bladder can hold and whether you are able successfully to pee it all out again. Worse was jumping up and down with a full bladder and tubes attached to check the workings of bladder and sphincter. But I ticked all the correct boxes to progress on to the operation itself.

Thankfully, a general anaesthetic was agreed for that though the operation can be done under epidural. An overnight stay was needed post-op, and apart from a little weakness and delicate wobbliness around the lower abdomen, I was to take it easy for a few weeks, then gradually ease back into driving and sports.

The operation has been a total success, and one year later I'm still drip-free and feel like I have a new lease of life. I'm unaware of the tape and there are no visible scars, but what everyone has noticed is my new-found confidence. My only regret is not finding help sooner, and I urge any woman who feels the slightest pelvic weakness to stop suffering in silence, get control and get strong.

Even after the TVT, it's important to exercise, and for most women, exercise is the key to total pelvic success. Once you're toned down there, you'll find it easy to squeeze-hold at any time of the day. Better still, step your pelvic strength up a level with Pilates, and your body will feel and look better both inside and out.

Tighten up your muscles

Whether you suffer or not, it's vital to keep your bladder and pelvic-floor muscles strong and healthy. If you think you have a problem, have it checked at your GP or women's health clinic.

* Avoid lifting heavy objects, which can cause strain.

* To test your tone, do your own biofeedback: put two clean fingers into your vagina and see how much you can squeeze against them. Use a mirror to check if your vagina closes and perineum lifts away from the pelvis when you squeeze.

* Identify your pelvic-floor muscles by tightening the muscles around your vagina and anus as though you were trying to stop yourself passing water and wind at the same time.

* Draw the muscles upwards and inwards, while breathing normally, and without tensing your stomach or thigh muscles. Practice holding the muscles tight for 10 seconds, though you might not be able to do this right away.

* You can also practice fast contractions, holding the muscles for one second, with one second's rest in between.

* Aim to do one set of 10 fast, and one set of slow contractions, six times each day. Don't give up if you don't notice a difference right away this may take up to three months, but you'll see a change eventually.

* Make it a habit to draw in your lower abdomen as often as you can to improve pelvic-muscle endurance.

* Eat plenty of fresh fruit and vegetables to prevent constipation, an don't overstrain when on the loo.

* Any lower-abdominals work on a fitball is beneficial, as are Pilates pelvic-stability exercises and swimming.

Continence Foundation: www.continence-foundation.org.uk; confidential helpline: 0845 345 0165, Monday-Friday 9.30am-1pm