Lifestyle Changes and Physical Therapy
Before trying other, more invasive treatments, your doctor may suggest making changes to your daily habits. For example, avoiding alcohol and caffeine, drinking less fluid, and performing exercises that strengthen the muscles in the pelvic floor.

Medication
Your doctor may prescribe a low dose of estrogen in the form of a vaginal cream or patch. This can help strengthen tissues in the urethra, which may reduce incontinence. Alternatively, you may be prescribed drugs that prevent bladder contractions or that help improve the strength of the urethral sphincter (the muscle that holds the urethra closed).

Insertable Devices
A urethral insert is a small plug that is inserted directly into the urethra before an activity that typically causes stress incontinence. This device is not intended to be left in place for long periods of time and must be removed before urination.

Another insertable device is the pessary. Pessaries are small, stiff rings that are inserted into the vagina to help support the bladder. Unlike urethral inserts, pessaries can be worn all day.

Other Therapies
Radiofrequency therapy uses radiofrequency energy to heat the tissue in the lower part of the urinary tract. The tissue is usually firmer when it heals, which may help reduce incontinence.

A second nonsurgical treatment is a series of injections that introduce a bulking agent, such as collagen, into the tissue around the urethra. The bulking agent helps keep the urethra closed.

Surgical Treatments
There are several types of surgical procedures used to treat stress urinary incontinence.

• In the suburethral sling procedure, a narrow strip of material is placed under the urethra. Some surgeons sew both ends of the sling to the abdominal or vaginal wall while others prefer to use tension-free slings that are not sutured in place. This creates a sort of hammock for the urethra while supporting and strengthening it.
  
  The sling itself may be made from three different types of material:
  
  Biodesign: Biodesign Advanced Tissue Repair Products are a whole new category in tissue repair, combining the best attributes of synthetic mesh and biologic grafts. The Biodesign Tension-Free Urethral Sling is a natural material that communicates with your body, signaling it to grow new tissue across the sling. Once the healing process is finished, the sling is completely remodeled into your own tissue.
  
  Synthetic Mesh: Some slings are a synthetic mesh made from a type of plastic called polypropylene. Although mesh is commonly used, it can cause problems after implantation. The body may respond to the mesh as a foreign material, causing the mesh to become surrounded by scar tissue. Or the mesh can erode the surrounding tissue. In 2008, the FDA issued a public health notification regarding complications of synthetic mesh.
  
  Biologic Grafts: Derived from human or animal tissue, biologic grafts typically allow cells to grow into the graft and replace it, a process called remodeling. Some biologic grafts are made from skin tissue, which makes them prone to stretching and bulging. Other biologic grafts are chemically cross-linked to strengthen the material. However, when these grafts are implanted, your body may respond to them as if they were a synthetic mesh.
  
  
• Bladder suspension surgery is used when the neck of the bladder and the urethra have dropped, or sagged out of their normal place. In the procedure, the bladder neck, urethra and part of the vaginal wall are lifted back into their proper location and attached to the bones and ligaments of the pelvis. This can be performed either by open abdominal or laparoscopic surgery.
  
  
• Anterior vaginal repair may be used in cases where the bladder or urethra have fallen, or sagged, into the vagina. The procedure involves moving the bladder back into its proper position and tightening the front wall of the vagina to hold the bladder in place. For more information on this type of repair, please see our section on Pelvic Organ Prolapse.