Management of urinary incontinence in postmenopausal women: An EMAS clinical guide

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

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: 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. Aim: The aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women. Materials and methods: Literature review and consensus of expert opinion. Summary recommendations: 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.

Original languageEnglish
Pages (from-to)223-230
Number of pages8
JournalMaturitas
Volume143
DOIs
StatePublished - Jan 2021

Keywords

  • Aging
  • Estrogens
  • Menopause
  • Midurethral slings
  • Urinary incontinence

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