# Conservative Treatment in Stress Urinary Incontinence—Narrative Literature Review

## TL;DR

This review summarizes non-surgical treatments for stress urinary incontinence in women, emphasizing pelvic floor muscle training as the best first step.

## Contribution

The paper provides an updated narrative review of conservative SUI treatments, highlighting PFMT as the gold standard and guiding personalized treatment approaches.

## Key findings

- Pelvic floor muscle training is the most effective first-line conservative treatment for reducing SUI symptoms.
- Other conservative therapies have weaker or more variable evidence and are best used as adjuncts or alternatives.
- A personalized, stepwise approach can delay or avoid surgery in many women with SUI.

## Abstract

Stress urinary incontinence (SUI)—urine leakage during effort, coughing, or sneezing—affects up to one in three adult women and has a major impact on their quality of life, even if many women do not seek help. This narrative review summarizes current evidence on non-surgical (conservative) treatments for SUI, including pelvic floor muscle training, electrical stimulation, tibial nerve stimulation, acupuncture, pharmacological options, vaginal estrogen, pessaries, and urethral bulking agents. Pelvic floor muscle training remains the gold-standard first-line therapy, with strong evidence for reducing leakage and improving quality of life when exercises are correctly taught and maintained over time. Other modalities can be used as adjuncts or alternatives in selected patients, especially when surgery is not desired, or it is contraindicated. Overall, a personalized, stepwise approach starting with conservative measures can control symptoms in many women and may delay or avoid the necessity for surgery, while also improving pelvic health before any eventual surgical intervention.

Background: Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence in women and significantly their affects quality of life. Aim: The aim of this study was to summarize the current evidence about conservative (non-surgical) treatments for female SUI and outline their clinical applicability. Material and methods: A narrative review was performed using structured research involving medical databases over the last 15 years, including systematic reviews, randomized controlled trials, observational studies and key guidelines regarding pelvic floor muscle training (PFMT), electrical and tibial nerve stimulation, acupuncture, pharmacological therapies, local estrogen, pessaries and bulking agents. Results: PFMT represents the primary first-line therapy, with strongest evidence for reducing leakage episodes and improving quality of life when performed correctly and consistently. Other conservative options (electrical and tibial nerve stimulation, acupuncture, duloxetine, local vaginal estrogen, pessaries and bulking agents) may be efficient for selected patients, but generally they have a weaker or more heterogeneous evidence base. They are considered adjuncts or tailored alternatives when PFMT alone is insufficient, not feasible or not accepted. Conclusions: Conservative management, centered on PFMT, should be offered as initial treatment to most women with mild to moderate SUI, with additional modalities being used selectively according to symptom profile, comorbidities and patient preference. A stepwise, individualized approach can control symptoms in many women and may delay or avoid surgical therapy.