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Meet the Pessary

A simple device for managing incontinence and prolapse symptoms

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 the vagina, similar to how you use a tampon or menstrual cup. While being worn, it supports the position of the vagina, bladder, rectum, and/or uterus. It can relieve symptoms like pelvic pressure, constipation, and urinary leaking. Some are over-the-counter, while others require a prescription by your doctor. A pessary can be used alone, or together with pelvic floor physical therapy and medical care to address bothersome symptoms. A pessary can be used as a long term or short term solution, worn continuously or as needed. Pessaries require minimal upkeep, mostly regular cleaning. Overall, they are a low risk treatment option and can be used to avoid surgery for incontinence and to aid in pelvic floor rehab for incontinence and prolapse. About half of women who are successfully fitted with a pessary continue to use it long-term.

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Knowledge is power! So, a very simple anatomy lesson is in order. Understanding a little anatomy can demystify the pessary and how it works.

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 of a baby from the uterus. The outer genitalia is the vulva. (Anatomy diagram below.) The pelvic organs - bladder, rectum, and uterus - are next to the vagina. Sometimes one or more of these organs sags and presses against the vaginal wall. 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. When the urethra and bladder are properly positioned, 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 masked the incontinence. While leaking may be temporarily increased, it’s actually an opportunity to address the cause of leaking for this person. So 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 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 can also be removed on your own, as long as you’re willing and able to do so.)

Most pessaries can be self- inserted and removed, depending on the individual’s ability to do so and their reasons for using one. Pessaries can be used as stand-alone solutions to leaking, or in conjunction with other medical care and physical therapy to eventually wean off of pessary use. The usage depends on each person’s needs, preferences, and lifestyle. Wearing a pessary is not “cheating”, and they're not only for extreme cases. Considering treatment options in the context of each individual’s symptoms, anatomy, and lifestyle is the key to finding the right care.

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