Urinary incontinence and menopause: an evidence-based treatment approach.

OBJECTIVE

To review the evidence on risk factors, evaluation, diagnosis, and treatments in postmenopausal women with incontinence.

DATA SOURCES: Articles on urinary incontinence were located by searching Medline and the Cochrane Database of Systematic Reviews in March 2000.

RESULTS

Urinary incontinence is common with aging. The relationship between urinary incontinence and menopause is not well understood. There are 3 major types of urinary incontinence: stress, urge, and mixed. The diagnosis can often be established with a good history. For a long time estrogen was thought to be of benefit in the treatment of incontinence, however, there is now evidence it may exacerbate urinary incontinence. There are multiple new agents shown to be effective in the treatment of incontinence. Surgical approaches for the treatment of stress incontinence have not been studied in large clinical trials, however, open abdominal retropubic suspension seems to be better than anterior vaginal repair.

CONCLUSIONS

As the aging population grows, urinary incontinence will become an increasing public health problem. Increasing awareness is needed by women and their providers to identify, evaluate, and apply evidence-based treatment approaches to urinary incontinence.