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A wee problem is finally solved; A new injection, just like the one used to create fuller lips, is being hailed as a cure for "stress incontinence". JOYCE WALTER tests the waters...

Byline: JOYCE WALTER

EVER laughed so hard you've wet yourself? Some of us may have experienced it but, for more than one in four women, urinary leakage is no laughing matter - it's an embarrassment they live with every day.

But a new treatment for stress incontinence could lead to relief all round. Called Zuidex, it uses hyaluronic acid, the same gel-like material cosmetic surgeons use to plump up women's lips. This is injected to "bulk up" the area around the neck of the bladder and make it watertight.

It may sound daunting but the procedure is done under local anaesthetic and takes about 30 minutes.

Stephen Foley, a consultant urologist at Battle Hospital, Reading, has been using the product in clinical trials over the past year and explains that traditional operations to treat incontinence require a general anaesthetic and have a longer recovery time.

"Zuidex is a big advance because it employs a device which allows us to ensure an accurate placement of the bulking material around the urethra (urine tube)."

The procedure is done by either a urologist or gynaecologist, in an ordinary treatment room - there's no need for an operating theatre. Although you won't feel much under anaesthetic, the first 48 hours afterwards can be uncomfortable, warns Mr Foley.

"There will be mild discomfort in the first day or two and about 10 per cent of patients find that in the first 24 hours they can't pass water normally, which could then require a catheter. But most women are back to normal activities in 48 hours.

The "stress" in stress incontinence is actually physical and has nothing to do with your emotional state. It refers to the sudden pressure on the bladder when, for instance, you sneeze, laugh, cough or undertake exercise, which causes urine to leak out.

The problem typically starts after a woman gives birth, which weakens the ring of muscles that support the bladder and keep the urethra shut when not passing water. Hormonal influences, both during pregnancy and at the menopause, and being overweight, can also contribute.

"Any woman who has delivered two babies vaginally will have a degree of incontinence," says Mr Foley. "A lot of women accept this as a 'penalty' for having babies. But the reality is that they don't have to put up with it. Things have changed."

Zuidex is best for treating moderate stress incontinence which doesn't respond to physiotherapy or pelvic floor exercises. Trials show that 17 out of 20 women will either be cured or show a significant benefit.

Zuidex does not always give a permanent result and additional treatments may be required. However, unlike collagen implants (see the box on the right), trials indicate the gel remains stable for a good few years, without the need for regular "top-ups".

Because Zuidex has only just been licensed in the UK, it may be difficult to find a doctor who has been trained to use it. However, programmes are under way, so the treatment will become more widely available on the NHS over the next year or so.Treatments for incontinencePelvic floor exercisesYour first option is to tone and tighten the muscles supporting the bladder. Special vaginal cones, electrical stimulation and/or biofeedback can be used. Ask your doctor to refer you to a physiotherapist for assistance, or contact the Continence Foundation for detailed instructions.

Pressure devices These are inserted into the vagina like a tampon and help to support the neck of the bladder. They can reduce or completely stop leakage in some women while they are worn but they are not a cure. When you stop using them, your problems will return. Surgery A number of surgical options are available - all of which aim to support and stabilise the bladder neck. These include colposuspension - the most major operation but with a very high cure rate, and various vaginal "sling" procedures. The latest technique is the use of "tension-free vaginal tape" (TVT). Here, a Velcro-like tape is inserted through small incisions just above the pubic area. It can be done as a day case, under either local or general anaesthetic. It is not readily available yet on the NHS and is still being evaluated for long-term results.

Other injectables Both collagen and a synthetic polymer are being used to bulk-out the bladder neck in a similar way to Zuidex. However, they are not as straightforward for doctors to use and tend to lose their effectiveness with time.

Help and information The Continence Foundation helpline: 0845 345 0165, (Monday to Friday, 9:30am to 1pm) www.continence- foundation.org
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Title Annotation:M Health
Publication:The Mirror (London, England)
Date:Nov 21, 2002
Words:761
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