Meet the Pessary

Most people have never heard of a pessary. So if you don’t know what it is, you’re not alone!

A pessary is a helpful tool that supports the female pelvic organs. It’s a simple device that’s inserted into and worn in the vagina. While being worn, it supports the position of the vagina, bladder, rectum, and/or uterus. It can relieve symptoms like pelvic pressure and urinary leaking. Traditionally, pessaries are fitted and prescribed by a clinician. A pessary can be used alone, or together with pelvic floor physical therapy to address bothersome symptoms. A pessary can be used as a long term or short term solution. Overall, they are a well-established conservative (non-surgical) care option for incontinence and prolapse. Typical use cases include wearing pessaries to restore continence and/or comfort during exercise, postpartum, or during perimenopause.

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Knowledge is power! So, a very simple anatomy lesson is in order to explain how the pessary works with our anatomy.

The vagina is an internal organ - the muscular passageway leading from the uterus to the outside of the body. The vagina receives penetration during sex, and allows passage of menstrual blood and a baby from the uterus. The pelvic organs - bladder, rectum, and uterus - are next to the vagina. Sometimes one or more of these organs sags and presses against the wall of the vagina. This is a prolapse. A prolapse is only a medical issue if it results in bothersome symptoms. The change in organ position can sometimes affect continence and voiding. In this case, a person may benefit from wearing a pessary. A pessary worn in the vagina prevents the organs from sagging against the vaginal wall. With improved support, leaking may become more manageable or resolved. Another type of urinary dysfunction is difficulty voiding because the kinked position of the urethra from a prolapsed bladder is making it harder to get urine out. In this case, it’s possible that leaking occurs once the pessary is worn, because the pessary “fixed” the position of the urethra. The prolapse had been masking the incontinence. While leaking may be temporarily increased, it’s actually an opportunity to address the cause of leaking for this person. It's a good thing!

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Pessaries come in many shapes and sizes. They are typically shaped as rings, discs, or cubes that fit inside the vagina. Custom pessaries are prescribed and fitted by a physician, ideally one who specializes in urogenital health and is very familiar with fitting pessaries. Fitting can take several appointments to get the right one - this is a very important step. The right size and shape are necessary, otherwise the pessary can be ineffective or uncomfortable and result in a negative experience and a missed opportunity.

Non-custom pessaries are sold over-the-counter without a prescription at your local drugstore or supermarket. Some of these options are disposable (one time wear), others can be cleaned and reworn. These usually come in a few sizes, with sizing kits used to figure out which size is right for you. These pessaries are designed to be easy to self-insert and remove, similar to how a person handles a tampon or menstrual cup, and are typically worn daily or during exercise. In contrast, custom pessaries that are prescribed and fitted by a doctor can be worn for up to several months at a time, with regular check-ins and cleanings at the doctor’s office. This may be a good choice for those who are unwilling or unable to insert and remove it on their own, and for those whose sexual activities will not be affected by continual pessary wear. (Custom pessaries may also be inserted and removed on your own. Speak with your doctor about this first.)

Pessaries can be used as stand-alone solutions to leaking, or in conjunction with other care, like physical therapy and pelvic floor exercises, to wean off of pessary use. Pessary use depends on each person’s needs, preferences, and lifestyle. Wearing a pessary is not “cheating”, and they're not only for extreme cases. The 'right care' considers treatment options in the context of each person’s symptoms, anatomy, and lifestyle.