Conservative Treatment in Stress Urinary Incontinence—Narrative Literature Review

Abstract

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.