WITHIN the last week the government has accepted the recommendations of an independent review, looking into the use of plastic mesh for the management of stress urinary incontinence in women, and as a result has ordered this treatment to be halted for the present time.

Initially seen as a godsend when it first came out, the simple procedure involves inserting the mesh through the vagina to support the bladder and other organs which have prolapsed, for example after childbirth.

However, after reports of the mesh slicing through other organs and complications ranging from chronic pain through to even death in one case, some have labelled it “the biggest health scandal since thalidomide”.

Urinary incontinence is a serious and disabling issue, conservatively estimated to affect three and a half millions individuals in the UK.

Although much more common in women, it does affect the male population too.

Broadly speaking, there are two types, stress and urge incontinence, with mixed being a combination of both.

If you imagine the bladder as an upturned hot water bottle, urge incontinence is due to the bladder being over irritable and the muscle at its neck not being strong enough to control it until a socially appropriate moment.

Stress incontinence is due to weakness of the muscles of the pelvic floor, which support the bladder.

Damage to these may happen after childbirth, or abdominal or gynaecological surgery.

Sufferers leak urine when they cough, sneeze, or exercise.

I would urge anyone with urinary incontinence to seek the help and support of their GP rather than suffer in silence.

Basic measures involve addressing alcohol and caffeine consumption, as both these worsen symptoms. Weight loss reduces pressure on the bladder and stopping smoking should have you coughing less.

FIRST line treatment for urge incontinence is bladder retraining, which involves slowly increasing the time between each trip to the toilet.

If this is unsuccessful, medications called anticholinergics may be used, which reduce the irritability of the bladder, lessening the spasms which cause urine to leak.

Managing stress incontinence starts with pelvic floor exercises with the aim of strengthening weakened muscles.

Although there are several devices you can buy over the counter, it may be sometimes difficult to actually isolate the right muscles and hence there are specialist services available where you can be taught the correct technique.

The exercises should form a regular part of your schedule.

If pelvic floor exercises do not provide the desired result, the next step would be a referral to a dedicated pelvic floor surgeon, to assess your case. The surgical management of both types of incontinence is a specialist area.

Treatments for urge symptoms including injecting Botox into the bladder muscle to help it relax, nerve stimulators which control the nerves supplying the bladder, and techniques to enlarge the capacity of the bladder itself.

For stress incontinence there are now dedicated pelvic floor surgeons, and thankfully there are options other than mesh slings to help patients whose cases require this level of input.