Even though women are generally open with each other, many find certain topics just too uncomfortable to discuss.

Urinary incontinence (bladder weakness leading to involuntary leakage of urine) is a very common condition that affects 1 in 4 women over the age of 35. It is a complaint that many sufferers are embarrassed to talk about and so delay seeing their doctor about it. But attitudes are changing, and recent television adverts for incontinence products, showing a young, fit dancer, reflect that.

In women, there are two main types of incontinence, stress and urge. Stress incontinence is leakage when you cough, sneeze or exercise. Urge incontinence is having the sudden urgent need to pass urine but not being able to get to the toilet in time. The causes and treatment of the two types are different.

Stress incontinence

What causes it? The most common cause is pelvic floor weakness, usually brought on by pregnancy and vaginal delivery. This underlying weakness is aggravated by being overweight, which puts additional strain on the pelvic floor muscles. After the menopause, lack of hormones affects all the pelvic organs, including the bladder and the pelvic floor muscles, and can make the situation worse.

What can you do to avoid it?
As with many conditions, prevention is better than cure. Pelvic floor exercises should be done rigorously by all women in the months following childbirth. This is, sadly, easier said than done for many women, as there are a lot of other things to think about, and precious little free time. But any time spent is valuable, and those who manage to continue with some sort of pelvic floor exercise programme from that point onwards do reduce their risk of developing stress incontinence.

Keeping your weight down, and exercising regularly to maintain all over good muscle tone, also help reduce the risk.

What can you do when you've got it? The first step is to get back to doing regular, daily, pelvic floor exercises. If you're not absolutely sure how to do these properly, see your GP or practice nurse for advice and instruction. For mild stress incontinence, this may be all that's needed to put things right.

For those with a more severe problem, or if 2-3 months of regular pelvic floor exercises hasn't helped, see your doctor. More effective pelvic floor strengthening may be achieved with the use of vaginal cones or pelvic floor physiotherapy.

Vaginal Cones
These are a set of weighted cones that are used in sequence to exercise the pelvic floor muscles. The lowest weight cone is used initially, inserted like a tampon (complete with string so that you can easily remove it). The idea is to contract the pelvic floor muscles to stop it falling out. This usually is impossible at first, but with daily use, eventually, that cone stays put, and then you move on to the next weight. The cones can be ordered through a pharmacy or can be obtained mail order or via the internet.

Pelvic floor physiotherapy
Most surgeries have access to a pelvic floor physiotherapy service using a female physiotherapist. The treatment is essentially 'slender tone' for the pelvic floor, using electrodes and a gentle electric current. This does involve having an electrode placed inside the vagina to get the best results. Once the treatment course is finished, she will advise you how to maintain the improvement with a range of pelvic floor exercises, or may point you in the direction of a 'home kit' for continuing electrical stimulation. The home kits use external electrodes only, but are often good enough to maintain the benefit from pelvic floor physiotherapy.

What about incontinence products?

For years, women have struggled with sanitary products to use on a daily basis, or on a 'just in case' basis when exercising. The ready availability of purpose-made urinary incontinence products is a huge step forward. The pads are more absorbent and include an advanced odour control system. They can be popped in your supermarket trolley with no fuss.

A wider range of incontinence products, for more severe incontinence problems, is available from specialist continence nurses, who can be accessed through GP surgeries