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Urinary incontinence in women
Background
Overview
Definition
UI is defined as involuntary or abnormal leakage of urine.
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Pathophysiology
UI has multiple possible causes, including age-related functional changes (overactive detrusor, impaired bladder contractility, decreased pressure in urethra closure, atrophy of urethral areas, prostatic hypertrophy), lesions in the CNS, excess urine output, restricted mobility, stool impaction, UTI, delirium, and medications (α-adrenergic agonists, α-adrenergic antagonists, anticholinergics, cancer drugs, calcium-channel blockers, diuretics, opiates, sedatives).
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Epidemiology
The prevalence of any symptom UI is high in the adult population, with an estimated age-standardized prevalence of 51.1% in women and 13.9%, in men respectively.
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Disease course
Clinical manifestations include urine leakage and, depending on the etiology, associated LUTS of urgency, frequency, nocturia, weak urination, and incomplete emptying associated.
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Prognosis and risk of recurrence
UI is a predictor of death in the general population and geriatric population. UI is associated with psychological morbidity and may lead to substantial impairment of QoL.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of urinary incontinence in women are prepared by our editorial team based on guidelines from the European Association of Urology (EAU/EAUN 2025), the American Academy of Family Physicians (AAFP 2024,2019), the Canadian Urological Association (CUA 2024), the American Physical Therapy Association (APTA 2023), the Society of Obstetricians and Gynaecologists of Canada ...
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Diagnostic investigations
History and physical examination: as per EAU/EAUN 2025 guidelines, elicit a complete medical history, including symptoms and comorbidities, and perform a focused physical examination in female patients with LUTS, including UI. Perform a standardized cough stress test in all female patients presenting with stress UI.
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Laboratory tests
Post-void residual volume
Urodynamic studies
Urinary tract imaging
Urinary biomarkers
Diagnostic procedures
Medical management
General principles: as per EAU/EAUN 2025 guidelines, use a shared decision-making approach when deciding on appropriate treatment for stress UI.
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Duloxetine
Anticholinergics and beta-3 agonists
Vaginal estrogen
Systemic estrogen
Management of asymptomatic bacteriuria
Management of constipation
Management of fall risk
Nonpharmacologic interventions
Behavioral modifications
As per APTA 2023 guidelines:
Offer behavioral interventions, including dietary and fluid modification and urge suppression techniques, to improve symptoms of urgency UI, urinary urgency, and/or urinary frequency.
B
Consider offering mindfulness-based stress reduction to reduce symptoms of urgency UI, urinary urgency, and/or urinary frequency.
C
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Smoking cessation
Weight loss
Bladder training
Pelvic floor muscle training
Mechanical devices
Electromagnetic stimulation and electroacupuncture
Therapeutic procedures
Urethral bulking agent injections: as per EAU/EAUN 2025 guidelines, offer urethral bulking agent injection in female patients seeking surgical treatment for stress UI following a thorough discussion of the risks and benefits relative to other surgical modalities.
A
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Vaginal electrical stimulation
Vaginal laser therapy
Tibial nerve electrical stimulation
Indwelling urinary catheter
Perioperative care
Surgical interventions
Indications for surgery
As per EAU/EAUN 2025 guidelines:
Offer different surgical procedures, where appropriate, and discuss the advantages and disadvantages of each approach in patients who have explored/failed conservative management options.
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Counsel female patients with UI regarding the following:
increased risks associated with surgery, together with the lower probability of benefit, in elderly patients and in patients with obesity
B
surgery for mixed UI is less likely to be successful than surgery for stress UI alone
A
one single treatment may not cure mixed UI and it may be necessary to treat other components of the incontinence problem as well as the most bothersome symptom
B
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Mid-urethral slings
Autologous fascial slings
Retropubic colposuspension
Artificial urinary sphincter
Adjustable compression device
Excision of urethral diverticulum