Lets face it, my days of trampolining are well and truly over. Elspeth, (my best friend) is on the phone to me, close to tears. It seems that since turning 50, she cannot so much as cough, laugh, or jump on a trampoline, without how can I put this delicately? Peeing her pants or stress incontinence as it's more formally known. I had no idea trampolining was so important to you, I say, in a feeble attempt to console her, while simultaneously going on-line to book a check-up with a specialist pelvic physiotherapist, Kate Walsh. This is not going to happen to me. And who knows, if Walshs advice rings true, perhaps she can prevent it happening to Elspeth. Prevention is better than cure and all that.

A few days later, legs akimbo on the couch in the clinic, Walsh, a friendly Liverpudlian whose work for the NHS and in private practice has led her to treat tens of thousands of women over the years with mild incontinence brought on by the peri-menopause, examines my pelvic wall, with what I quickly come to understand is typical candour. I wish I had a Go-Pro on my fingers sometimes, she says, people would be fascinated by what you can tell from inside the pelvis! Hmm. But would they want to see it? I wonder, squeamishly.

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Walsh has no such qualms. People stop me in shops in the Wirral where I live and theyll whisper, My mum needs to see you, she has a prolapse! And Ill think, Why are you whispering?! Her concern is that our silence around the subject means that so many women are unaware that you can treat stress incontinence and go for years suffering from shame and embarrassment, when often there are simple solutions to hand. I once had an 80 year old woman tell me she keeps pads under her pillow; waits until her husband falls asleep, and then puts them in her underwear. She doesnt want him to know that this is what she has to do now. I find this story terribly sad, and also slightly scary is this the future? until Walsh continues, But we can do things for women who are 80! We can do things whatever your age - we just need to talk about it more.

The reason its more common around our mid forties onwards is because our hormone levels are changing. Oestrogen in particular is very important for the integrity of the soft tissues, and the support it gives, so once your oestrogen levels drop, the tissue of the vagina becomes more papery, she explains. Thats when vaginal atrophy sets in, the thinness sets in, and problems take hold.

Sounds like hell, I say. What can we do to make sure This Does Not Happen? Firstly the front wall of the vagina, which doesnt support the bladder as well as it should because of the change of hormones, needs to be strengthened. We should all be doing pelvic floor exercises, either with the help of a device like Elvie or without - theyre easily mastered but require regular practice if youre going to see improvements. When we laugh, cough or sneeze, we generate pressure in the abdomen, says Walsh, And this squeezes the bladder. Normally the vaginal wall supports the fascia and the muscles come up, suppress the urethra and keep you continent, without you even knowing it. But with stress incontinence, in the case of your friend, you lack the ability to tighten up.

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To strengthen the fascia, a treatment like ThermiVas, which Walsh performs regularly, via the insertion of a warm wand which emits radio frequency technology to tighten the internal walls of the vagina, is great, as theres no down time and most see an instant improvement.

There are now so many options, says Walsh, from injecting a filler into the urethral sphincter, to meche, where a tape is added to the neck of the bladder so it has additional support. At the first hint of a problem, you should see a doctor. And be prepared to be told to put the work in yourself. Recently I attended a conference in Scotland where they debated the complications surrounding meche, says Walsh. And what it boils down to is, we all need to try the more sustainable solutions first treatments like radiofrequency, and exercising at home.

Get ready to start squeezing.

Try: If youre worried about losing control of your bladder and find yourself going more often to the loo as a precautionary measure, try not to. Walsh says youre just creating a sense of panic, and making the situation worse by creating an overactive bladder. Never go just in case and never leave it until youre bursting - aim for something in between. You need to show your bladder whos boss and for most of us that means six to eight times within 24 hours.

Buy: My Pelviva is a new pelvic floor muscle trainer that you insert like a tampon into your vagina. It then sends electric pulses to stimulate and strengthen the muscles. 84% of women reported improved bladder control after 12 months of use.

Do: If you get the chance to book in with Kate Walsh, do! You can find her in clinics across Merseyside and in London at Mallucci London.

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