[Urinary incontinence--taboo during postmenopause]

Urinary incontinence affects 30-60% of all women in the postmenopause. More and more women want to remove the taboo attached to incontinence, because they do not accept the reduction in quality of life, social and domestic activities. Detrusor instability (urge incontinence) and/or urethral sphincter incompetence (genuine stress incontinence) are the principal mechanisms, which lead to involuntary urine loss in older women. It is quite evident that additional factors as hypoestrogenism and urogenital atrophy influence urinary incontinence. Since in the postmenopause urge incontinence combined with urogenital atrophy its found predominantly, pharmacologic therapy with anticholinergic drugs and estrogen replacement are generally effective. Surgical therapy should be restricted to older women with genital prolapse and/or stress incontinence. In genuine stress incontinence, estrogen replacement therapy can lead to subjective improvement, but urodynamic parameters do not change objectively.