What is the most appropriate intervention for a 68-year-old woman experiencing urinary incontinence with intense urgency?

The most appropriate intervention for a 68-year-old woman experiencing urinary incontinence with intense urgency is the use of intravaginal estrogen cream (Premarin cream). This treatment is particularly effective in postmenopausal women who may experience urinary incontinence due to hormonal changes that lead to vaginal atrophy and a decrease in pelvic floor support. The estrogen can help restore vulvar and vaginal tone, improve urethral function, and alleviate symptoms of urgency, which can reduce episodes of incontinence.

This approach addresses the underlying dryness and atrophy that can exacerbate urinary urgency and frequency in menopausal women, thereby offering a targeted remedy aligned with her symptoms. The other interventions may have different mechanisms of action or target conditions that are not primarily related to menopause-induced urinary symptoms.