The prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care.
The aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women.
Literature review and consensus of expert opinion.
Healthcare professionals should consider urinary incontinence a clinical priority and develop appropriate diagnostic skills. They should be able to identify and manage any relevant modifiable factors that could alleviate the condition. A wide range of treatment options is available. First-line management includes lifestyle and behavioral modification, pelvic floor exercises and bladder training. Estrogens and other pharmacological interventions are helpful in the treatment of urgency incontinence that does not respond to conservative measures. Third-line therapies (e.g. sacral neuromodulation, intravesical onabotulinum toxin-A injections and posterior tibial nerve stimulation) are useful in selected patients with refractory urge incontinence. Surgery should be considered in postmenopausal women with stress incontinence. Midurethral slings, including retropubic and transobturator approaches, are safe and effective and should be offered.
Maturitas. 2020 Sep 30 [Epub ahead of print]
Eleonora Russo, Marta Caretto, Andrea Giannini, Johannes Bitzer, Antonio Cano, Iuliana Ceausu, Peter Chedraui, Fatih Durmusoglu, Risto Erkkola, Dimitrios G Goulis, Ludwig Kiesel, Irene Lambrinoudaki, Angelica Lindén Hirschberg, Patrice Lopes, Amos Pines, Margaret Rees, Mick van Trotsenburg, Tommaso Simoncini
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy., Department of Obstetrics and Gynecology, University Hospital, Basel, Switzerland., Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain., Department of Obstetrics and Gynecology I, "Dr. I. Cantacuzino" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania., Instituto de Investigación e Innovación de Salud Integral (ISAIN), Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador., İstanbul Medipol International School of Medicine, Istanbul, Turkey., Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland., Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece., Department of Gynecology and Obstetrics, University of Münster, Münster, Germany., Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece., Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden., Nantes, France Polyclinique de l'Atlantique Saint Herblain. F 44819 St Herblain France, Université de Nantes F, 44093, Nantes, Cedex, France., Sackler Faculty of Medicine, Tel-Aviv University, Israel., Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK., Department of Obstetrics and Gynecology, University Hospital St. Poelten, Lilienfeld, Austria., Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy. Electronic address: .