Incontinence: A woman's little secret

Often, it starts after the baby's born: You head to aerobics class, ready to shed those extra pounds, and in the middle of the workout ... an accident.

This embarrassing little problem is urinary incontinence, and lots of women - regardless of age - are secretly dealing with it. More than three million people in the UK have incontinence, and women are more likely to have it than men, according to the NHS. About 20% of women over 40 years old suffer from urinary incontinence, defined as the accidental passage of urine. The rates of urinary incontinence increase with age. It is thought that almost half of people with incontinence, about 45%, wait five years or more before asking for help.

"It's embarrassing, and it can really affect your quality of life - your emotional state, body image, sexuality," says Dr Linda Brubaker, a professor of female pelvic medicine.

Yet many put up with incontinence needlessly, Brubaker tells us. "People don't realise it's a medical condition, and that there's help. Many women think it's normal, part of having children or going into menopause."

Though incontinence is "more common than you might think," it's not normal says Brubaker, who sees teens, and women in their twenties, thirties or older with this issue. "You don't have to put up with it. There are often simple solutions that work."

4 types of urinary incontinence

When you can't control the release of your urine, you have urinary incontinence. For some the problem can be as minor as the rare dribble, for others as problematic as wetting your clothes. There are four kinds of these problems:

• Stress incontinenceis that little leak that happens when you cough, laugh, sneeze - any motion that stresses or puts too much pressure on the bladder.
• Stress incontinence can result from pregnancy and childbirth, when pelvic muscles and tissues can be stretched and damaged. It can also occur from high-impact sports, as a result of ageing or from being overweight.
• Urge incontinenceaka “overactive bladder,” is a bit different - it's the urgent need to go, followed by an involuntary loss of urine - with anything from a few seconds to a minute's warning. It is thought to be due to spasms of the bladder muscles.
• Conditions such as multiple sclerosis (MS), Parkinson’s disease or a urinary tract infection can cause urge incontinence.
• Mixed incontinencemeans you have more than one type of incontinence, with stress and urge incontinence being the typical mix.
• "I think most women have both types," adds Brubaker. "I don't believe there's as much distinction between the two types as we might think."
• Overflow incontinence. If you can't empty your bladder every time you go to the toilet and experience a frequent or constant dribbling of urine, you have overflow incontinence.

Certain medication can cause this problem, and people with nerve damage from diabetes or men with prostate issues can also experience this type of incontinence. It is due to impaired bladder muscle contractions or bladder obstructions.