There are several alternative treatment options available. The most appropriate treatment for patients whose health conditions are not compatible with surgery or anaesthesia is a vaginal pessary. A pessary is a rubber (or silicone) ring that is placed in the vagina, between the posterior fornix and the pubic bone, to support the uterus.

The ring must be inserted in a medical clinic and must be replaced regularly (every 6-12 months), in order to carry out an antiseptic treatment to avoid pressure sores and vaginal infections. For the treatment of mild-moderate stress incontinence, the alternatives to surgery are:

• perineal rehabilitation consisting in perineal physiotherapy (contracting the pelvic floor muscles in order to strengthen them), possibly combined with biofeedback (the same muscle contraction exercises carried out with the aid of a vaginal probe) and with perineal electrostimulation (which is appropriate when muscle contractions alone are inadequate);
• local oestrogen therapy, using vaginal creams or ovules, an option that is particularly suitable for postmenopausal women. Lastly, it is important to remember that, in the case of urge incontinence, the treatment option able to improve symptoms, is anticholinergic medication.