When women get together they are notoriously open about their problems, and have no qualms about gossiping about their sex lives, their ailments, their money problems, their kids and anything else that comes up over a bottle of wine or three! However us girls clearly don’t talk about everything and there are still some taboo subjects that we are too nervous to broach with our friends. It is estimated that over 4 million women in the UK over the age of 18 suffer from SUI (Stress Urinary Incontinence)1. SUI is the accidental leakage of urine during physical exertion, or activities such as sneezing and coughing2 and the risk factors are pregnancy, childbirth and menopause3. Three out of four women do not seek treatment4 because they are embarrassed. In addition 1 in 4 women with SUI say they feel less confident than they used to be4. Many women feel it is a sign of ageing, when in fact 26% of sufferers are under 30 years of age4. SUI doesn’t just knock your confidence, it can affect your relationships with your partner and can prevent your ability to exercise.

	Kirsty wants to know: "How common is SUI?"
Dr Sarah Jarvis said:	SUI, sadly, is incredibly common. It affects 4 million women in the UK. Even more sadly, huge numbers of women who have SUI think they are the only ones. Only about 1 in 4 women who suffer from SUI seek help for it and at least half of those wait for a year or more before they do so.
	Betty White wants to know: "At what age are women most affected by SUI?"
Dr Sarah Jarvis said:	SUI can affect women of any age, but it gets much more common after pregnancy and around menopause. 1 million women in the UK under 30 suffer from SUI - it's very much not an just an old women’s disease.
	Vicky wants to know: "Is there any cure for SUI? "
Dr Sarah Jarvis said:	Not everybody can be cured of SUI, but virtually everybody can find ways to improve their symptoms - as long as they pluck up their courage to ask for help.
	Vicky wants to know: "Does it get worse as you get older? "
Dr Sarah Jarvis said:	SUI is usually caused by weakness in the muscles of your pelvic floor. It tends to come on after pregnancy or childbirth, but it often gets worse around the menopause. Putting on weight and smoking (which gives you a chronic cough) can also make it worse. If you don't treat it, you may find it gets worse as you get older and your muscle tone falls off.
	Daisy wants to know: "Do pelvic floor exercises help with this problem?"
Dr Sarah Jarvis said:	Is the Pope Catholic?! Yes, absolutely, pelvic floor exercises may have been around for a long time, but they are still the first line treatment for SUI. There is now a tablet available to help women who have moderate to severe SUI (2 or more episodes of incontinence a day) but even for these women, it's essential to keep up your pelvic floor exercises. The trouble is, many women don't do them regularly enough or over a long enough period for them to make a real difference, and assume that this. means they're no use.
	Lisa G wants to know: "Where can I find instructions on how to do pelvic floor exercises?"
Dr Sarah Jarvis said:	Your first port of call should always be your GP or practice nurse. They should be able to teach you the basics (they really aren't complicated!) Or refer you to a physiotherapist who can give you more details and instructions.
	Dorothea wants to know: "I have tried pelvic floor exercises and I still suffer from a little incontinence. Should I seek medical treatment?"
Dr Sarah Jarvis said:	It would really be worth your while talking to your GP, especially if pelvic floor exercises haven't done the trick. You need to do them several times a day for at least a couple of months to make a real difference. If you have done your pelvic floor exercises religiously, your GP might suggest a tablet that can help, or referral to a physiotherapist. She can teach you how to make your pelvic floor exercises more effective, or give you vaginal cones (a kind of weight shaped like a tampon) that you can use in your vagina to improve the tone of your pelvic floor.
	Pauline wants to know: "I work in a warehouse and sometimes have to move quite heavy objects, the last couple of times the pressure of lifting has made me wee slightly, not only embarrassing but I'm concerned I have some sort of urinary infection"
Dr Sarah Jarvis said:	You're describing the classic symptoms of SUI - leaking urine when you cough, sneeze, laugh, exercise or lift. If you don't have any burning or stinging when you pass your water, and you're not feeling the urge to wee more often than usual, it's unlikely that the cause is anything other than SUI. Once again, you need to start doing regular pelvic floor exercises - and in your case, passing water regularly and learning to lift properly (the sort of techniques that protect your back) might help too.
	Pam wants to know: "Will sex aggravate SUI?"
Dr Sarah Jarvis said:	No, fortunately not - but having sex can increase the pressure inside your tummy (think of all that bouncing up and down!) in the same way as coughing, sneezing or other forms of exercise. That means that sadly many women are put off having sex because of the embarrassment of leaking urine when they are intimate. Some women also find that they leak urine when they orgasm. Fortunately for all those patient husbands and boyfriends, pelvic floor exercises will do wonders for your love life as well as your SUI.
	Fredrica wants to know: "Can too much sex lead to incontinence?"
Dr Sarah Jarvis said:	Most women would be only too happy to have that conundrum! Sex is a very common cause of Cystitis, a form of urine infection that can make incontinence worse. Other than that, sex is quite good for your pelvic floor - especially if you practice your pelvic floor exercises while you're having sex.
	Brian wants to know: "My wife is very embarrassed about her SUI and it's ruining our sex life! What can I do to make her feel sexy again? "
Dr Sarah Jarvis said:	Good for you! Far too many women are too embarrassed to mention the problem even to their husbands, and far too many men don't have the insight to realise how demoralising a problem SUI is. Explaining to your wife the benefits of pelvic floor exercises for SUI and your love life should help. In the short term though, try turning the lights down, running a warm bath with plenty of candles and champagne, and make love in the bath.
	Imogene wants to know: "Is there a natural/alternative remedy for SUI?"
Dr Sarah Jarvis said:	You don't get more natural than pelvic floor exercises! Don't forget that you can do them any time, anywhere - in the bus, on the train, while sitting watching telly. You really should be thinking about making them as much part of your everyday routine as brushing your teeth. There is some evidence that complementary treatments like osteopathy can help.
	Kelly wants to know: "I have heard that acupuncture can help SUI - do you recommend this?"
Dr Sarah Jarvis said:	I haven't heard of this as a remedy, but as I mentioned before, there is some evidence for other complementary treatments. It's certainly worth talking to a registered practitioner.
	Helen wants to know: "Is SUI hereditary? "
Dr Sarah Jarvis said:	Just today, an article appeared in the British Medical Journal about this very subject. It seems that you are more likely to suffer from SUI if your older sister or mother have it. Fortunately, unlike them, you will have access to effective medical treatment if pelvic floor exercises don't keep the problem at bay. If SUI does run in your family, it's all the more important for you to take steps to prevent it. For instance, many women worry that doing pelvic floor exercises during pregnancy will reduce their chances of a natural birth. In fact, there is good evidence that doing these exercises during pregnancy will not only cut your risk of SUI afterwards, it will actually reduce the chance of you needing a forceps delivery.
	Sarah G wants to know: "Does this condition get worse for those women who have had surgery in that region?"
Dr Sarah Jarvis said:	It can do, if the pain or problems you've suffered make it more difficult for you to exercise your pelvic floor muscles. If the nerves in your pelvic floor are damaged by surgery, that can also cause problems with incontinence (but not usually SUI). It may be that if you find it difficult to exercise your pelvic floor because of surgery, the new medication for SUI, which increases the tone in the muscles that keep your bladder neck shut, will be especially helpful.
	Janet wants to know: "Are there any products specifically designed to hide the smell? "
Dr Sarah Jarvis said:	Sanitary towels are not usually specifically designed to disguise the smell of urine incontinence. However many panty liners and feminine hygiene pads are designed with exactly this in mind. I would advise that you don't use too much in the way of vaginal deodorants or highly scented products to disguise the smell, as they can irritate your tender nether regions.
	Nicola wants to know: "When I am menstruating I sometimes find I have less control of my bladder. Is this usual?"
Dr Sarah Jarvis said:	It's certainly not unheard of. It's possible that your female hormones, which go up and down during the course of your menstrual cycle, can affect pelvic muscle tone as well as abdominal bloating, breast tenderness and irritability (although we'd never admit that to the chaps!). Wearing tampons may also press on your urethra (the tube your wee passes out through) and you bladder neck, where the muscles that stop you weeing are found.
	Sarah wants to know: "Are they developing a medical cure for SUI? "
Dr Sarah Jarvis said:	Unfortunately, there is no cure on the horizon for SUI. However, there is now a tablet licensed for the treatment of moderate to severe SUI (at least two episodes of incontinence a day) that has been found to halve the number of episodes in at least half of women who take it. Combining this medication with pelvic floor exercises is likely to make it even more effective.
	Sarah wants to know: "Are there any specific products (reinforced pants) that I can wear? "
Dr Sarah Jarvis said:	There are some products available from medical suppliers, but I am afraid they aren't very glamorous. They also aren't available on the NHS, so over time they are very expensive. I really would recommend that instead of giving up and resorting to hiding the problem, you pluck up your courage to talk to your GP about solving it. You may be embarrassed but your GP will have dealt with this problem hundreds of times before.
	Vicky wants to know: "How can I help my partner understand it? "
Dr Sarah Jarvis said:	That's a really tough one - but leaving this web page open will be a good start! As we have mentioned before, this problem is often brought on by pregnancy and childbirth - and making your partner realise that having his children helped create the problem will put it into perspective. On a more serious note, sitting down and explaining to him how it makes you feel, and its effect on your self esteem, would be a good move - but do make sure that you are both feeling relaxed and are unlikely to be interrupted. With luck, it should be a long conversation.
	F wants to know: "Where can I turn to for further information?"
Dr Sarah Jarvis said:	Your first point of call should be your GP or practice nurse. Don't forget, they will have heard it all before, and won't think you are wasting their time. In addition, you can contact The Continence Foundation on www.continence-foundation.org.uk or Incontact on www.incontact.org.uk Good Luck! I really hope you have found this a useful opportunity to find out more about an incredibly common problem. I have certainly appreciated the chance to get across the message that SUI is eminently treatable, and you don't have to suffer in silence. I hope today will help you to pluck up the courage to seek the help you deserve.

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