Pessaries for Prolapse and Urinary Incontinence

September 10, 2019 Angelique Montano-Bresolin

By Cara McDougall, Reg. PT

What is it?

A pessary is a removable silicone device that is inserted into the vagina like a tampon.

Purpose

Pelvic organ prolapse: to lift/support the pelvic organs from below and decrease symptoms of heaviness, pressure or bulging.
Stress urinary incontinence: to decrease urinary leakage by compressing the urethra (the tube that drains the bladder).

A pessary is a conservative management option that can greatly improve quality of life for those women suffering from symptoms of pelvic organ prolapse or stress urinary incontinence. Pessaries are a great adjunct to pelvic health physiotherapy and are often considered when a client is not a candidate for surgery (either because symptoms are not severe enough to warrant the risks of surgery, other medical conditions prevent surgery from being an option, or the woman elects not to have surgery). Unfortunately, pessaries do not work for all women; sometimes a woman’s anatomy does not support the use of a pessary or the woman’s body cannot tolerate the pessary. However, due to the extremely low risk involved with pessary use, it is definitely worth exploring to see if it is a good option for you!

A Successful Pessary…

Your symptoms of pressure, heaviness, and/or bulging are reduced or gone
You cannot feel the pessary
Improved urine and stool evacuation
Reduced or abolished urinary incontinence
The pessary stays in place and does not fall out with slight bearing down (cough, bowel movement)
Overall improved quality of life

Using a Pessary

A pessary must be fitted for you by someone trained to do so (specialized doctors, nurses, or physiotherapists). There are different shapes and sizes of pessaries.
Depending on your symptoms and overall health, it may be left in for weeks or months or removed daily. If it is to be removed daily, your physiotherapist will teach you how to remove, clean and insert the device. If it is to be left in for months, you will likely see a nurse or doctor each time it is removed, cleaned, and re-inserted.
Some clients wear their pessary all day long and others only insert it for activities where they feel they need a little extra support. For example, during exercise class or while going for a walk or run.
Your doctor may prescribe an estrogen cream or other topical to keep your vaginal tissue healthy.

Pessary Care

Wash with mild unscented soap and rinse well (eg. Spectro Gel, unscented Dove soap).
Pessaries can last many years; they only need to be replaced if cracks develop on the surface.

Intercourse

All, except the ring pessary must be removed for penetrative intercourse.

Menstruation

Only the ‘ring’ and the ‘ring with support’ types of pessaries can be worn during menstruation but must be removed nightly.
Do not use a tampon or Diva cup when using a pessary.

Potential Risks of Pessary Use

Increased vaginal secretions
Irritation or fissure at the vaginal opening
Infection
Erosion of vaginal tissue
Migration of pessary into soft tissue

Medical Follow-up Care

It is recommended that you see your physician one (1) month after starting to use a pessary and then every 6-12 months to ensure health of your vaginal tissues. Your physiotherapist will educate you on warning signs to look out for and when to seek medical attention.