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captiongoodhealth. 57 s U rinary incontinence affects  about 50 per cent of women at some stage in their life. For some it’s a just a  hassle, for others it can ruin their quality of life so they feel unable to socialise or continue physical activity. To know how best to deal with incontinence, it helps to first know what type you have. There are three types: stress incontinence, urge incontinence and overflow incontinence. Some women may  have a combination of two. If  you’re unsure, see your GP, who  may refer you to a  continence  nurse, women’s health physiotherapist, urogynaecologist or urologist. The good news is that most women can be cured or at least have their symptoms improved. Urogynaecologist Professor Andrew Korda, of Sydney Urodynamic Centres, explains. Stress incontinence Symptoms: Leakage of urine on exertion – when you cough, sneeze, laugh, or run up and down stairs. Solutions w Pelvic floor exercises can cure about 60  to 80 per cent of women, whatever their age. Because so few women perform pelvic floor squeezes correctly, a visit to a  women’s health physio is recommended. It’s important not to bear down, or use abdominal, thigh or buttock muscles or hold your breath. Ideally, you should imagine you’re trying to stop wind, prevent a tampon falling out or stop your flow of urine mid-stream (although that shouldn’t be performed as an exercise). Initially, you should aim to hold the contraction while breathing normally, gradually increasing to a 10-second hold, something that may take up to six months to achieve. The 10:10:10 formula is recommended; that’s 10 10-second squeezes 10 times a day.w Oestrogen creams: Menopausal women find creams applied locally help  strengthen the tissues.w Surgery: If there’s no improvement with pelvic floor exercises there are around 300 surgical options. Good surgeons have an 80 to 85 per cent success rate.  For some women,

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caption58 distractions such as breathing exercises or mathematical puzzles.w Drugs: These act on the nervous system of the bladder. However, it usually takes time to find the best drug and dose for each woman. Ideally, doctors want to prescribe the lowest dose possible as the drugs have side effects such as dry mouth, reflux and constipation. They are taken indefinitely.w Oestrogen cream.w Acupuncture: There is evidence that if you stimulate certain nerve roots in the sacral area of the spine, it can help overcome an overactive bladder. This is done by acupuncture in the lateral tibial nerve on the outside of the lower leg. Edward McGuire, a US scientist and urologist, first discovered this during experiments with incontinent monkeys and gave a lecture tour in China about his discovery – only to find the Chinese had been using the procedure for 1000 years!w Botox into the bladder: This relaxes the bladder but is expensive, has to be repeated and doesn’t always work – patients may urinate the Botox out. w Hypnotherapy: There’s a strong association between an overactive bladder and neuroticism and some people have found hypnotherapy effective. Many studies have shown that some women are unable to perform pelvic floor contractions correctly. There are a range of devices on the market that claim to help, but do they work? Eleanor Lee-Bognar, a Sydney-based women’s health physiotherapist, says that, just like any strength training equipment, you need to get your technique right first and it helps to get some advice from a  trainer. Here, she explains some of the latest gadgets available to help you overcome incontinence. Common causes of incontinence * Childbirth, during which the muscles, nerves and ligaments of  the pelvis are traumatised. * Menopause, leading to oestrogen deficiency. * Urge incontinence increases with age and stress incontinence is most common in women aged 40 to 50. * Some medications relax the

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caption59 Photography corbis / getty images / snapper media Biofeedback exercisers These include the PFX2. Women insert a  vaginal sensor, like a tampon, attached to a device that incorporates a read-out gauge. When you contract your pelvic floor, you get a read-out of the strength and duration of the contraction. Good for: Women who have mastered a correct pelvic floor contraction and who like to monitor their improvement. Older women with dryer vaginal tissue who can find other devices uncomfortable. Need to know: Because the gauge responds to air pressure, it is possible to get a high reading when you’re bearing down and using abdominal pressure – which can make matters worse – rather than a pelvic floor contraction. Unlike straight pelvic floor contractions, you can’t do these while going about your daily business. You’ll need to put aside dedicated exercise time. Vaginal weights These include vaginal cones such as Aquaflex or Teneo Balls. They are a series of cones or balls which are available in different weights. The presence of the cone in the vagina should cause a contraction of the pelvic muscles to hold it in place. As the muscles get stronger, the weight of the cones can be increased. Good for: Younger women with stress incontinence who don’t want to put aside time for exercises. Need to know: They work more effectively when you’re in an upright position so are best used standing up. Some women have a tendency to use their gluteal muscles instead of their pelvic floor to keep the cones in place, so don’t use these before first building up a bit of strength. Some women may not be aware they have very tight, or overworked, pelvic floor muscles and the use of weights can  trigger pain over time. Spring exercisers These include Kegelmaster and look like spring-loaded tongs. You insert the two arms into the vagina then try to clamp them together. Need to know: The correct