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Recognize when to see your doctor. Submit to any diagnostic testing. Ask about medication options. Consult your physician about surgical options.
If your symptoms don’t improve from steps at home or if the leakage begins interfering with your activities of daily life, then make an appointment with your doctor. Your doctor will have a variety of steps available based on the severity and other specifics of your case, including both medications and surgical intervention in severe instances. Give your doctor a complete picture of your medical history and tell him what steps you’ve already tried. Your doctor will perform a physical examination of your abdomen and genitals, likely asking you to clench several muscles in the process. She may also want to run other diagnostic tests, which may include:  Urine sample testing for infection, the presence of blood, or abnormalities that would increase the sensitivity or irritability of your bladder A neurological examination to identify any nerve damage in the pelvis A urinary stress test, during which the doctor will observe for urine loss while you cough or bear down Bladder function testing, which will measure the amount of urine left in the bladder after urination and pressure inside the bladder Your doctor will likely encourage you to continue with home treatment steps (possibly even augmenting your routine). He may also recommend a medication to help reduce your stress incontinence. Medications that can help with mild to moderate cases include:  Anticholinergic medicines—oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), and trospium (Sanctura)—to help relax the bladder muscles and reduce contractions and leakage Antimuscarinic drugs—atropine, solifenacin—to stop bladder contractions (may increase the amount of urine left in the bladder after emptying) Imipramine—a tricyclic antidepressant—that relaxes the bladder muscles to help with full evacuation Estrogen creams and vaginal tablets or rings that can help women who have gone through menopause to increase the strength of the pelvic floor muscles When all other options have failed to relieve your stress incontinence symptoms, your doctor may suggest surgical options as a last resort. Your doctor will base the recommendation of a specific procedure on your sex and other criteria. Options include:  Anterior vaginal repair, which restores vaginal walls strength when bladder prolapse is involved (the bladder bulging into the vagina). Artificial urinary sphincter, which is a device used mainly in men to stop urine leakage. Collagen injections, which thicken the area around the urethra to reduce leakage. This option can require multiple procedures. Retropubic suspension, which is a procedure that lifts the bladder and urethra to reduce strain and pressure. Vaginal sling procedures, which support the urethra with the use of a sling to reduce strain and pressure.