Which of the following is an appropriate management for stress incontinence in adults?

• A. Pelvic floor exercises
• B. Bladder training
• C. Antimuscarinic medications
• D. Sling surgery

Answer: (A)

Stress incontinence mainly comes from weakness of the pelvic floor and urethral support, so the most effective first step is strengthening those muscles to keep the urethra closed when there’s a rise in abdominal pressure. Pelvic floor muscle training, often called Kegel exercises, directly targets this issue and has strong evidence showing it reduces leakage and improves continence with consistent practice and proper technique. Bladder training is geared toward urge symptoms and overactive bladder, not the loss of support that causes stress incontinence. Antimuscarinic medications reduce detrusor (bladder) overactivity, which helps with urgency rather than with the structural support needed for stress leakage. Sling surgery is a more invasive option that’s usually reserved after conservative measures have failed or in more severe cases. Starting with pelvic floor exercises provides a safe, noninvasive, and evidence-backed approach to address the underlying problem.