Which description best matches the recommended first-line management for stress incontinence?

Which description best matches the recommended first-line management for stress incontinence?

• A. Urinalysis and antibiotics
• B. Pelvic floor muscle training (Kegels) for at least 3 months
• C. Immediate surgery
• D. Behavioral therapy only

Answer: (B)

Strengthening the pelvic floor with targeted exercises is the preferred first-line management for stress incontinence. This approach works by improving the support and function of the pelvic floor muscles, which helps maintain continence when there is a rise in abdominal pressure from coughing, sneezing, or lifting. When done correctly and consistently, pelvic floor muscle training strengthens the levator ani group and improves urethral closure, reducing leaks. A structured program that teaches proper technique, with regular practice over at least three months, yields the best evidence for symptom improvement. Guidance or supervision from a clinician or physical therapist often enhances technique and adherence, making outcomes more reliable.

Other options don’t address the underlying mechanism as effectively. Urinalysis and antibiotics target infection, not pelvic floor support. Immediate surgery is reserved for cases that don’t respond to conservative measures. Behavioral therapy alone can help some individuals, but without the specific strengthening of the pelvic floor, it’s less likely to provide strong, lasting relief for classic stress incontinence.