What is the most common cause of urinary incontinence in postmenopausal women?

• A. Urge incontinence due to detrusor overactivity
• B. Functional incontinence due to immobility
• C. Stress incontinence due to pelvic floor weakness
• D. Overflow incontinence due to underactive detrusor

Answer: (C)

Postmenopausal urinary leakage most commonly comes from stress incontinence due to pelvic floor weakness. The pelvic floor muscles and surrounding support tissues hold the bladder and urethra in place; childbirth can stretch and weaken these structures, and the drop in estrogen after menopause further reduces tissue tone. When there’s sudden increases in abdominal pressure from coughing, sneezing, or lifting, the weakened support allows the urethra to escape closure and urine leaks out.

Urge incontinence from detrusor overactivity can cause leakage with a sudden urge, but it’s not the predominant mechanism in this group. Overflow incontinence from underactive detrusor is less common in women, and functional incontinence from immobility is tied to difficulty reaching the toilet rather than pelvic floor weakness.