Ever laughed so hard you wet yourself? Most of us know that feeling, but for more than one in four women, urinary leakage is no laughing matter - it's an embarrassment that they live with every day, and which they usually keep to themselves.

Over the last four or five years or so, new injectable solutions for stress incontinence have offered new treatment options, which appear to be encouraging more women to come forward for help. One of these, Zuidex, uses hyaluronic acid, the same gel-like material which cosmetic surgeons use to plump up women's lips and lines, along with a special applicator device, to bulk up the neck of the bladder and make it more watertight. The procedure is quick and can be done under a local anaesthetic, similar to what your dentist might use.

Mr. Stephen Foley, a consultant urologist at Battle Hospital Reading, first used the product in clinical trials and has had many years experience with it. He says that it's not uncommon for women undergoing the treatment to be in and out of hospital in just half an hour. This is a big difference over most other procedures for stress incontinence which can require a general anaesthetic and either open surgery or the use of a cystoscope (keyhole surgery viewing tube) to accomplish, with 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 without having to use a telescope. Other products call for a telescope to ensure correct needle placement but Zuidex is designed to be placed blindly, but highly accurately," explains Mr. Foley.

To ease any discomfort, an anaesthetic gel is rubbed into the skin around the sensitive urethral area, before injecting the local anaesthetic. Then the placement device is inserted to firmly hold open the wall of the urethra, guiding the positioning of the Zuidex gel containing a natural sugar substance (hyaluronic acid) which is made from bacteria grown in a lab.

The procedure is done by either a urologist or a gynaecologist, in an ordinary treatment room - there is no need for an operating theatre. While you won't feel much under anaesthetic, the first 48 hours afterwards could well be uncomfortable, warns Mr. Foley. "There will be some mild discomfort in the first day or two and about 10% 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, except drier, he says.

The 'stress' in stress incontinence is physical and has nothing to do with your emotional state. It refers to the sudden pressure on the bladder, when you sneeze, laugh, cough or during exercise, which causes urine to leak out. The problem can begin at any age, but typically starts after childbirth, which weakens the ring of muscles supporting the bladder and which keep the urine tube (urethra) shut, when not passing water. Hormonal influences, both during pregnancy and at the menopause and being overweight can also contribute.

Says Mr. Foley, "Any woman who has delivered two babies vaginally will have a degree of incontinence. I've met very few women who've had babies who can star jump or skip anymore and stay dry. A lot of women accept this as normal and part of the penalty of having babies. But it stops many of them from exercising and the reality is, they don't have to put up with it. Things have changed over the last five years, and now there are many more options on offer."

Zuidex is best for treating moderate stress incontinence, which doesn't respond to physiotherapy or pelvic floor exercises. Initial trials show a reasonable success rate: 17 out of 20 women will either be cured on their incontinence or show a significant benefit. However, Zuidex does not always give a permanent result and additional treatments may be required in some cases. Unlike collagen implants, however, early trial evidence indicates that the gel remains stable for a good few years, without the need for regular 'top-ups'.