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Urinary incontinence, urgency, overactive bladder symptoms, cystitis and urinary tract infections are common conditions that collectively trouble over one-third of the female population around and beyond the time of menopause, with a detrimental effect on physical, social and mental wellbeing. Apart from pharmacological and surgical treatments, a long list of lifestyle, behavioural, physical and complementary interventions have been introduced over the years to relieve lower urinary tract symptoms. This review examines the effect on these symptoms of lifestyle factors (such as weight, smoking, dietary components, fluid intake, exercise and bowel habit), complementary therapies (such as herbal remedies, acupuncture and hypnotherapy), behavioural therapies (bladder training and timed and prompted voiding), pelvic floor muscle training and some over-the-counter preparations. The high prevalence of the above conditions in combination with the increasing publicity for and awareness of the subject has contributed to the popularity of the interventions considered in this review. Many of them, however, lack a solid evidence base with regard to their efficacy and few have been subjected to robust randomized trials. It is widely recognized that there is a need for further prospective interventional studies of all lifestyle interventions to evaluate the effects of modifying these factors on lower urinary tract symptoms.

Approximately 16–29% of women will complain of incontinence at the menopause. A multidisciplinary approach to treatment is essential and surgery is usually reserved for women who have failed to improve sufficiently with conservative measures, such as pelvic floor exercises. The Burch colposuspension remains the 'gold standard' procedure for stress urinary incontinence, against which all newer procedures are compared. It is normally carried out under general anaesthesia and requires an abdominal approach, most often by a low transverse incision. Tension-free vaginal tape (TVT) is the most popular procedure at present and has largely replaced colposuspension in many units. However, there are concerns about both its long-term safety and the lack of data on efficacy beyond the first few years. Initial reports of transobturator tape suggest that it may have a similar efficacy to TVT but with a lower rate of serious complications; however, large comparative studies and longterm follow-up data are currently unavailable. Collagen and silicone injected around the urethra can be used in a selected group of patients under local anaesthetic but the success rates are disappointingly low.