Treatment			Comments
Behavior therapy
	Pelvic floor muscle (Kegel) exercises		Safe but time consuming. Appropriate in highly motivated patients with ability to contract pelvic muscles who have no evidence of pelvic prolapse.
		…with biofeedback	Improves patient’s ability to correctly identify contraction of pelvic muscles. No evidence of long-term benefit for decreasing incontinence frequency.
		…with vaginal weights (cones)	May improve patient’s ability to correctly contract pelvic muscles.No evidence of benefit compared with Kegel exercises alone.
Medications
	Alpha-adrenergic stimulants		Not FDA-approved for treatment of stress incontinence. No good evidence of efficacy. May be appropriate in patients with other indications for these medications.
	Estrogen
	Duloxetine		Balanced and selective serotonin and norepinephrine reuptake inhibitor that increases urethral sphincter contraction during the storage phase of urination cycle. In final stages of FDA review.
Devices
	Extracorporeal magnetic innervation (ExMI) chair		Patient sits in an FDA-approved chair that stimulates pelvic muscles via a low-intensity magnetic field. Treatments are administered twice weekly in 20-minute sessions for 8 weeks. Appropriate in patients with uncomplicated, mild stress incontinence who have never undergone surgery.
	Intravaginal support devices		Can be used on a temporary or occasional basis, such as in patients with exercise-induced incontinence. Requires manipulation and manual dexterity.
	Pessaries		Can be used on a temporary or long-term basis; often used in older patients who have not responded to other therapies. Long-term use requires monitoring for vaginal infection and ulceration.
	Urethral occlusion inserts (plugs)		Can be used on a temporary or occasional basis, such as for exercise-induced incontinence. Requires manipulation and manual dexterity.
Invasive treatments
	Colposuspension procedures		Most effective treatment, but incontinence may recur over time. Best treatment in patients with stress incontinence accompanied by uterine prolapse.
	Tension-free vaginal tape procedure		Urethral sling created under local anesthesia, often in outpatient surgical unit. Effectiveness similar to that of colposuspension.
	Injection of bulking agents		Periurethral injection of collagen results in high short-term cure rates, but effectiveness diminishes over time. Appropriate in patients with difficult-to-control incontinence in whom urodynamic testing reveals intrinsic sphincter deficiency.