Stress urinary incontinence accounts for 50% of all urinary incontinence. First line management consists of pelvic floor muscle training, however if this fails then medication such as duloxetine or urethral bulking agents may be used. Duloxetine enhances external sphincter muscle tone by increasing serotonin and noradrenaline activity in Onuf’s nucleus. Urethral bulking agents work by increasing urethral coaptation. Both are offered as second line treatment or as a minimally invasive alternative to those unfit or unwilling to undergo surgery.