Understanding Pessaries: A Non-Surgical Solution for Prolapse & Incontinence
For many women navigating pelvic organ prolapse (POP) or stress urinary incontinence (SUI), pessaries can be a life changing treatment option! A pessary is a safe, effective, and often empowering tool that can support your pelvic floor and improve quality of life without the need for surgery.
What Is a Pessary?
A pessary is a soft, flexible medical device inserted into the vagina to provide internal support. Think of it like a sports bra for your pelvic organs—it helps hold everything in place and reduces the sensation of heaviness, bulging, or pressure that’s often associated with prolapse.
There are many different types of pessaries, including:
Ring pessaries – often used for mild to moderate prolapse
Cube and Gelhorn pessaries – more supportive and may hold better for mpre advanced prolapse or high impact loading
Dish or incontinence pessaries – designed specifically for bladder support and stress urinary incontinence, but may also be used for Prolapse
Pessaries are made from medical-grade silicone and come in a wide range of shapes and sizes to suit individual anatomy and symptoms.
How Do Pessaries Help?
Prolapse
Pessaries help reduce the symptoms of prolapse by physically lifting and supporting the vaginal walls and pelvic organs (such as the bladder, uterus, or rectum). This can ease:
Vaginal bulging or pressure
Low back or pelvic heaviness
Discomfort with prolonged standing or exercise
Many women find that a pessary gives them the confidence to return to movement, exercise, and daily life with reduced symptoms.
Stress Urinary Incontinence (SUI)
Certain pessary types (like the dish, ring or ring with knob) help support the urethra, reducing or even stopping urine leakage with coughing, sneezing, laughing, or exercise. They can be a fantastic solution for:
Leaking during high-impact activity
Leaking with cough, sneeze, laughing
Leaking due to urethral hypermobility
What to Expect During a Pessary Fitting
At our clinic, pessary fittings are performed by trained pelvic floor physiotherapists in a safe, private, and supportive environment. Here’s how it works:
Initial Assessment
We begin with a thorough pelvic floor assessment. This includes:
A detailed history of your symptoms, goals, medical background, and lifestyle
A vaginal examination to assess pelvic organ support, muscle strength, tissue health, and suitability for a pessary
Discussion around your preferences and if you want to move forward (e.g., if you'd like to remove and insert it yourself, or if you're looking for short-term vs long-term use)
Fitting the Pessary
Once we've confirmed that a pessary is a suitable option for you, we begin the fitting process in a supportive and private setting. The aim is to find the type and size that provides you with the best possible support, comfort, and functionality for your body and lifestyle.
Choosing the Right Type and Size: There are many types of pessaries—rings, cubes, dishes, and more—and each comes in multiple sizes. We start by selecting a shape based on your anatomy, symptoms, lifestyle goals, and whether you're interested in managing the pessary independently or prefer clinical support. We may try several pessaries in one session. Each is inserted gently with lubrication and assessed for how well it supports the vaginal walls and pelvic organs.
Testing Functionality: Bladder, Bowel, and Movement: Once the pessary is inserted, we guide you through a series of functional tests to ensure it stays in place and doesn't interfere with important functions:
Breathing and bearing down: You’ll be asked to gently bear down (as if opening your bowels) or cough to mimic pressure changes and test whether the pessary stays in place.
Bladder emptying: We assess whether you can still urinate freely with the pessary in place. A good-fitting pessary should not block the urethra or make it harder to empty your bladder.
Movement testing: You’ll be guided through real-life movements that reflect your goals—this may include:
Walking around the clinic
Squatting or sitting and standing from a chair
Lifting a weighted object (if relevant to your daily life or exercise)
Coughing or jumping (for those using pessaries for stress incontinence)
This helps us determine whether the pessary stays in place, continues to feel comfortable, and supports you in the activities that matter most to you.
A well-fitting pessary should not cause any discomfort. You should not feel pressure, rubbing, or irritation. Many women are surprised at how unnoticeable it feels once inserted correctly. We’ll take the time to make sure the fit is right—offering both support and ease.
We may need to adjust sizing or try a different shape to get the best result, and that’s completely normal. The fitting process is collaborative and led by your feedback.
Education and Follow-Up
We’ll teach you:
How to insert and remove your pessary (if you want to do this independently)
How to clean and care for it
Signs to watch for (e.g., discharge, irritation)
When and how often to come back for reviews
Follow-up appointments are important to monitor tissue health, ensure ongoing comfort, and make any changes as needed.
Is It Safe to Wear a Pessary Long-Term?
Yes, when fitted correctly and monitored regularly, pessaries are safe to use long term. Ongoing care is essential, and many women use a pessary successfully for years without surgery. If you're not comfortable managing it on your own, we can help with regular changes and check-ins.
Ready to Explore if a Pessary Is Right for You?
Our team of pelvic floor physios are experienced in pessary fittings and are here to support you with evidence-based, compassionate care. Whether you're managing symptoms of prolapse, incontinence, or simply want to stay active without discomfort, a pessary may be the solution you've been looking for.
