Relax now, you're home and dry : HEALTH

Linda Cordozo helps more than 700 women a year to overcome incontinence . Annabel Ferriman reports
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Linda Cardozo knows when she has cured her patients by the clothes that they wear after treatment. "When they first come to see me, they are usually wearing long cardigans, loose skirts and dark colours. They come back wearing white trousers or li ght-coloured skirts."

The transformation is due to the fact that they no longer suffer from incontinence, a disorder Professor Cardozo has been interested in for almost 20 years. Her dedication to an unfashionable, not to say taboo, subject was recognised earlier this year when she was given a personal chair at King's College Hospital, London, making her Britain's first professor of urogynaecology.

A dynamic, flamboyant woman of 44, Professor Cardozo does not conform to most people's idea of a middle-aged consultant gynaecologist. She is a fluent talker and snappy dresser, whose hobbies include flying light aircraft, horse riding and scuba diving. She is married to a dentist, and lives in north London with her three young children. And she is intent on changing people's attitudes to her speciality and to "wet women'', as she calls them.

"I am keen to promote the notion that incontinence is not a sin or a disgrace and that there is a lot you can do about it," she says. "That is one reason why I am so delighted to be given this chair. I feel it raises the status of urogynaecology, which, after all, is the fourth sub-speciality in obstetrics and gynaecology. That must be in the interests of women and their health needs."

Professor Cardozo, who qualified at Liverpool University Medical School in 1974, first became interested in incontinence while carrying out research in 1976-78. She now sees women from nine to 90 years old at her clinic, which has about 700-800 new referrals each year.

Incontinence is much more common than most people realise. An estimated three million adults and 500,000 children suffer from it. Almost all sufferers are women.

"The problem is that we women are very badly designed. We should really be walking on four legs instead of two. Dogs, cats and most other mammals hold up their abdominal organs with the strong muscles of the abdominal wall, whereas we walk on two legs and have to hold up our internal organs with our pelvic floor. That has to take all the strain. If you then make the pelvic floor weaker by having babies, taking up weight-training, lifting heavy shopping or carrying children around, the muscles cannot cope and you start to leak a bit."

Because of embarrassment, women are often slow to seek help - one survey found that half left it for five years before going to see their doctor - yet effective treatment is often available for those who seek it. There are around 320 continence advisers within the UK's health authorities, many of whom visit GPs' surgeries to see patients, and they are backed up by specialist services at most district general hospitals.

Some women achieve satisfactory results from relatively simple measures, such as pelvic floor exercises or drug treatment, but others do not get better unless they have surgery. Professor Cardozo's role is to ensure that women are given the correct diagnosis, and then surgery, where necessary.

The two commonest causes of incontinence in women are weakness in the urethral sphincter mechanism (at the opening of the bladder), usually after childbirth, and what is called detrusor instability - an overactive bladder, which contracts frequently and uninhibitedly, and which the patient cannot control.

"It is important that these two causes are differentiated from one another, because the treatment is quite different. The first, often known as stress incontinence, can be corrected by surgery, whereas the second, called urge incontinence, is treated mainly by drug therapy or habit retraining, known as bladder drill."

Physiotherapy, which involves teaching women to do pelvic-floor exercises to strengthen their muscles, has a one in five chance of curing someone who has only mild to moderate incontinence, but women have to continue to do these exercises every day for the rest of their lives. Surgery involves tightening the tissues around the neck of the bladder, is usually necessary in severe cases and, if successful, is permanent.

Treatment for detrusor instability is different. In mild cases, women can simply be advised to decrease their fluid intake and to avoid certain drinks, such as tea, coffee and alcohol, which act as diuretics. In more severe cases, drugs can make the bladder less likely to contract and the patient produce less urine. Unfortunately, these drugs can have unpleasant side effects, such as producing a dry mouth. "What I tell my patients is dry mouth - dry knickers," says Professor Cardozo.

Effective treatment transforms people's lives, as Professor Cardozo's patients testify. "She gave me back my life," Sarah Brown (not her real name), a 46-year-old civil servant from Bedfordshire, says. "I suffered from incontinence for four years, following a hysterectomy operation in 1990. I had two unsuccessful operations, which made it worse. I couldn't run, sneeze or cough without leaking. I had to regulate how much I drank. If I was going anywhere in the car, I had to plan the journey carefully, according to where there were toilets. I went to see Professor Cardozo this year and had a successful operation in August. Now I can do anything, wear anything. I can go on long walks with the dogs and I'm hoping to join a gym. I am back to normal."

Not surprisingly, Professor Cardozo finds her job very satisfying."It is incredibly rewarding on a personal level, especially when you see women who have been wet for 20 years. They say to me after successful surgery: `I don't have to cross my legs any more when I cough; I can pick up my granddaughter and throw her up in the air'."

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