If pelvic floor exercises fail to treat stress incontinence, what is the next step?

If pelvic floor exercises fail to treat stress incontinence, what is the next step?

• A. Mid-urethral sling
• B. Anticholinergic therapy
• C. Urinary catheterization
• D. Diuretic therapy

Answer: (A)

Stress incontinence happens when leakage occurs with activities that raise intra-abdominal pressure because the urethral support is insufficient. Pelvic floor exercises are a first step to strengthen that support, but when they don’t work, the goal is to restore urethral positioning and closure during stress. A mid-urethral sling achieves this by placing a small supportive sling under the urethra, creating a hammock-like support that helps compress the urethra as pressure increases, reducing leakage. This surgical approach is commonly chosen after conservative measures fail because it directly addresses the mechanism of leakage with a minimally invasive, effective solution. Anticholinergic therapy targets overactive bladder symptoms by reducing detrusor contractions, so it’s used for urge incontinence rather than stress incontinence. Urinary catheterization is a temporary drainage method, not a definitive treatment for stress incontinence. Diuretic therapy would increase urine production and likely worsen leakage rather than help.

Stress incontinence happens when leakage occurs with activities that raise intra-abdominal pressure because the urethral support is insufficient. Pelvic floor exercises are a first step to strengthen that support, but when they don’t work, the goal is to restore urethral positioning and closure during stress. A mid-urethral sling achieves this by placing a small supportive sling under the urethra, creating a hammock-like support that helps compress the urethra as pressure increases, reducing leakage. This surgical approach is commonly chosen after conservative measures fail because it directly addresses the mechanism of leakage with a minimally invasive, effective solution.

Anticholinergic therapy targets overactive bladder symptoms by reducing detrusor contractions, so it’s used for urge incontinence rather than stress incontinence. Urinary catheterization is a temporary drainage method, not a definitive treatment for stress incontinence. Diuretic therapy would increase urine production and likely worsen leakage rather than help.