One of the most controversial childbirth factors is whether the risk of urinary incontinence is increased by an episiotomy (a cut made in the tissues of the birth canal to allow easier passage of the baby). The latest evidence seems to suggest that episiotomies do not significantly increase the risk of urinary incontinence.
External factors can affect bladder control. For example, many medicines interfere with the function of the urinary tract.
Several types of urinary incontinence
Because the control of urine flow involves several elements, there are a variety of ways it can go wrong. Six different types of urinary incontinence are recognised - stress, urge, mixed, neurogenic, overflow and post-prostatectomy incontinence. The treatment you need will depend on which type of incontinence you have.
Menopause
The menopause, with its loss of female hormones, leaves many women vulnerable. Oestrogens are essential for helping the tissues keep their strength and elasticity. When levels fall, so delicate body tissues become dry and thin, and muscles more lax. As pelvic floor muscles support your bladder and help to keep the exit tube (urethra) tightly shut, a leaky bladder can be the result.
Although urinary incontinence becomes more common with age, it's not inevitable.
Avoiding surgery
.        Pelvic floor exercises are a simple way to improve bladder control, especially in stress incontinence (one much-used technique is called Kegel exercises). But you must practise them regularly and intensively for good effect. Ask physiotherapists about pelvic floor exercises or try vaginal cones (from any large chemist). These are special weights that you practise holding in your vagina to teach the pelvic floor muscles to contract.
.        Bladder training: there are many different techniques, such as emptying your bladder at fixed intervals (part of what's known as "bladder drill"), which may show improvements in as little as a week.
.        Oestrogens: hormone replacement therapy can be taken as tablets, patches or creams, and has been shown to significantly improve symptoms, especially in stress and urge incontinence.
.        Other drugs, which help to stimulate the nerves that control urine flow - or which tone up the bladder muscles, may be as effective as pelvic floor exercises.
.        Electrical stimulation of the pelvic floor may be effective therapy, both for stress incontinence and urge incontinence. In one study about one-third of the patients were cured or substantially improved.