American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy for women with stress urinary incontinence?

1. Pelvic floor muscle training

2. Anticholinergic medications

3. Surgical intervention

4. Biofeedback

The correct answer is: Pelvic floor muscle training

The first-line therapy for women with stress urinary incontinence is pelvic floor muscle training, often referred to as Kegel exercises. This approach focuses on strengthening the pelvic floor muscles, which support the bladder and help control urination. Studies have shown that pelvic floor muscle training can significantly improve symptoms and is a non-invasive option that can be effectively performed at home. This method is particularly beneficial as it empowers patients to take an active role in their treatment and does not involve medications or surgical risks. In contrast, other options like anticholinergic medications are more commonly used for urge urinary incontinence and may not address the specific needs associated with stress incontinence. Surgical interventions, while effective, are generally considered when conservative measures fail or when the patient has more severe symptoms. Biofeedback can be a helpful adjunct but is not typically the first option recommended. Thus, pelvic floor muscle training is well-supported by evidence as the most suitable initial approach for managing stress urinary incontinence in women.