Vaginal Pessaries: A Non-Surgical Ally in Treating Stress Incontinence and Pelvic Organ Prolapse
Introduction
An often underutilized tool that can provide immediate relief and long-term support for stress urinary incontinence and pelvic organ prolapse is the vaginal pessary. For individuals experiencing stress urinary incontinence or pelvic organ prolapse, pessaries can be a game-changer.
What Is a Vaginal Pessary?
A vaginal pessary is a small, flexible device inserted into the vagina to support areas affected by structural weakness. Pessaries come in various shapes and sizes and are typically made of medical-grade silicone. They are often used to support the bladder, uterus, rectum, or vaginal walls that may have shifted due to weakened pelvic muscles.
How Can Pessaries Help with Stress Urinary Incontinence and Prolapse?
Stress Urinary Incontinence (SUI):
SUI occurs when activities like coughing, sneezing, laughing, or exercising put increased pressure on the bladder and sphincters, causing urine leakage. Certain types of pessaries, such as the ring with support or dish pessaries, are designed to provide additional support to the urethra and bladder neck, reducing leakage by improving urethral closure during movement.Pelvic Organ Prolapse (POP):
Prolapse involves the descent of pelvic organ(s) into the vaginal canal due to weakened support structures. A pessary can reposition and support the organs, alleviating symptoms such as pelvic pressure, vaginal bulging, and discomfort during daily activities such as walking, standing, lifting, and exercising.
Benefits of Using a Pessary
Non-surgical option: A pessary offers symptom relief without the need for invasive procedures, making it ideal for those who wish to avoid or delay surgery.
Immediate symptom improvement: Many patients report significant improvement in symptoms right after fitting.
Customizable and removable: Pessaries can be fitted to the individual’s anatomy and removed for cleaning or intimacy, depending on the type.
Compatible with physical therapy: When used in conjunction with pelvic floor physical therapy, a pessary can enhance rehab outcomes by supporting the tissues during exercise and daily function.
Who Is a Good Candidate for a Pessary?
Pessaries are a great option for many people, including:
Those with mild to moderate pelvic organ prolapse (rectoceles, or prolapse of the rectum, don’t respond as well to pessaries)
Individuals with stress urinary incontinence
People awaiting pelvic surgery or those who prefer to avoid it altogether
How Are Pessaries Fitted?
A pessary fitting is typically done by a pelvic health specialist or provider trained in pessary management. Typically, this includes urogynecologists and OB/GYNs but may also include pelvic floor physical therapists who have done the necessary training. Once fitted, follow-up is important to ensure comfort, hygiene, and effectiveness. Some patients learn to manage their pessary independently, while others prefer routine care appointments for cleaning and checks.
Pessary Use and Physical Therapy: A Powerful Partnership
Incorporating a pessary into your pelvic floor rehab plan doesn't replace physical therapy—it complements it. By providing structural support, a pessary allows you to engage more fully in pelvic floor exercises, functional movement training, and lifestyle changes that are critical to long-term pelvic health. Most people find that they can actually activate their pelvic floor muscles more effectively with a pessary in place. Don’t worry, using a pessary will NOT weaken your pelvic floor muscles overtime.
Final Thoughts
Vaginal pessaries offer a safe, effective, and conservative approach to managing stress incontinence and pelvic organ prolapse. When paired with skilled pelvic floor physical therapy, they can significantly improve quality of life and help you return to the activities you love with confidence.
If you think a pessary might be right for you, speak with your trusted pelvic health provider and see if you are a good candidate!