What non-pharmacologic therapy is commonly considered first-line for stress or mixed incontinence?

• A. Surgical sling.
• B. Pelvic floor muscle training (Kegel exercises) with proper instruction.
• C. Bladder irrigation.
• D. Sacral nerve stimulation.

Answer: (B)

Pelvic floor muscle training with proper instruction is the best first-line nonpharmacologic approach because it directly strengthens the muscles that support the bladder and urethra. When the pelvic floor is stronger, it provides better urethral closure during activities that raise abdominal pressure—like coughing, sneezing, or lifting—reducing leakage in stress incontinence and helping with leakage seen in mixed incontinence. The key is proper technique and consistency: learning to activate the pelvic floor without engaging the abdomen or glutes, initially under guidance and then as a regular home program for several weeks to months. This noninvasive, low-risk method has solid evidence for reducing leaks and improving quality of life, making it the preferred starting therapy before considering more invasive options. Surgical sling is reserved for cases where conservative measures haven’t helped, bladder irrigation isn’t a treatment for incontinence, and sacral nerve stimulation is typically used for refractory symptoms.