Taboo

Urinary incontinence is a commonly-hidden health problem. "Society is not supportive of people living with incontinence - many are ashamed of it,' says Marcus Drake, Senior Lecturer in Urology at the University of Bristol and Chair of the International Continence Society (ICS) Standardisation Committee.

As a result it is often overlooked. 'There are charities that focus on it but there is no large and vocal advocacy group. You don't see many fun runs for incontinence," he says.

Urge for competence  

GPs get little training in incontinence care and few pursue the field, despite a huge demand for expertise, he says. People often do not seek medical help and when they do, treatment can be patchy and sometimes rationed.

However, treatment is not limited to incontinence pads. More effective treatments are becoming available for the two types of incontinence.

Medical solutions 

For stress incontinence (brought on by coughing, sneezing or running, and often a result of childbirth), a simple surgical procedure to install a mid-urethral tape can help. "Fitted by a skilled surgeon on suitable stress incontinent patients, this leads to a good outcome in the majority of cases," says Mr Drake.

New developments in the treatment of overactive bladder - characterised by urgency and frequency - include the new drug mirabegron.  "It tackles the symptoms with fewer of the side effects such as dry mouth and constipation, that have caused some people to give up on more conventional drugs," he says.

Trials are also going on in the use of mirabegron with the more conventional drug solafenacin.

Other new drugs include vesomni, which can be effective in men with urgency and difficulty passing urine.

Botox injections to the bladder can also be effective for people with severe urgency. Less common treatments include sacral neuromodulation and tibial nerve stimulation, both of which work on the nerves that link bladder and brain, but are expensive and unlikely to be mass treatments.