Q. How can we effectively treat stress urinary incontinence without drugs or surgery? A. Pelvic floor muscle training (PFMT) and intravaginal electrical stimulation seem to be the best bets. PFMT increases urinary continence and improves symptoms of stress urinary incontinence (SUI) (strength of recommendation [SOR]: A, systematic review or randomized, controlled trials [RCTs]). PFMT also improves quality of life (QOL) (activity and psychological impact) (SOR: B, 1 RCT). Intravaginal electrical simulation increases urinary continence and improves SUI symptoms; percutaneous electrical simulation also improve SUI symptoms and likely improves QOL measures (SOR: a, systematic review). Magnetic simulation doesn't increase continence, has mixed effects on SUI symptoms, and produces no clinically meaningful improvement in QOL (SOR: B, heterogeneous RCTs with conflicting results). Vaginal cones don't increase continence or QOL (SOR: B, 2 RCTs with methodoligic flaws)
