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A worldwide row is brewing following recommendations by the American College of Physicians that Kegel exercises, bladder training and, in some cases, weight loss are the most effective ways to treat urinary incontinence in women, and should be tried before the use of drug treatments.

This appears to fly in the face of the recent review of the UK NICE Guidelines that focussed entirely on surgical and pharmacological intervention and totally ignored developments in non-surgical, lifestyle and non-invasive physical therapies.

Lauren Streicher, MD, a leading US commentator, succinctly raises the key issue: ”Face it, if Kegel exercises worked, the adult diaper (nappy) industry would not be advertising on prime time television and would not be a gazillion dollar a year industry.” . This echoes the core argument made by British author Barry Fowler in The Kegel Legacy (ebook gbp1.99) published in 2013.

Streicher goes on to say: “It’s true that...

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