Everything You Need to Know About Pessaries: Benefits, Fitting, and Care

Pelvic organ prolapse (POP) is a common and often distressing condition experienced by postpartum folks. Some experience symptoms like vaginal heaviness, bulging while wiping and urinary leakage that onset right after childbirth while others start to notice symptoms as they become more active throughout their early postpartum recovery. Treatment options provided for those experiencing prolapse symptoms are often lacking and include a reluctant pelvic floor physical therapy referral and in many cases, a very premature consult for surgery.

Here’s the thing, pelvic floor physical therapy is a safe and incredibly effective treatment option for folks experiencing prolapse symptoms, but as is true with all conservative treatment methods, it requires time, patience and commitment. But there’s an extremely effective and underutilized third option that helps people feel better in the short term while they work with PT on long term results, and that’s pessaries.

What is a pessary?

A pessary is a device made of silicone that’s inserted vaginally to provide internal support. This device can help to significantly reduce symptoms during daily activity, exercise and can be used alongside physical therapy to improve quality of life.

For some, a pessary is a short term solution while they spend time gaining strength and building resilience in their body. Pessaries can also be used as a longer term solution for someone who isn’t responding to conservative treatments like physical therapy but does not wish to or cannot undergo surgery.

It’s important to note that far from everyone who experiences prolapse will need surgery. In fact, we are seeing more patients able to manage their symptoms and return to the activities they love through the use of a pessary and physical therapy. 

What kinds of pessaries are there?

There are different types of pessaries, and the one that is right for your symptoms will be determined by your provider.

A support pessary uses a silicone based round spring mechanism that is inserted vaginally to support from underneath the bladder and uterus. This is the foundation for the most commonly used type of pessaries. Additional components can be added to support pessaries for symptoms like leakage or extra pressure. 

A space occupying pessary functions differently, by filling up space in the vaginal canal.

When you are fit for a pessary, your provider will explain what kind of pessary they recommend for you based on their exam findings. For instance, a common type of support pessary is called a ring pessary. A ring pessary supports the uterus and additional support can be added to a ring pessary in order to support the bladder. A knob can also be added to a ring pessary to support the urethra. Depending on your symptoms and needs, your provider will choose the best pessary for you. One is not prognostically better than another, it is all just a matter of what your needs are. 

Who might benefit from a pessary?

Some symptoms that indicate the need for a physical therapy appointment and possible discussion of a pessary are excess pressure on the perineum, sensation of feeling like a dry tampon is stuck at the vaginal opening, feeling a bulge while wiping, or leakage with jumping, weight lifting, running, etc. 

Here are more examples that may indicate you need a pessary:

Various pessary types

• You have any of the symptoms mentioned above, and are postpartum or menopausal. 

• You have leakage with a specific activity, for example running or heavy weight lifting.

• Your symptoms worsen when you are on your feet for long periods of time.

• You want or need extra support while healing postpartum because you do not have the resources to dedicate toward strengthening right now.

• You are postpartum after your second (or third.. or fourth!) baby, and you are going to be picking up/carrying your toddler(s) and baby.

• You find yourself restricting your activity or your life due to fear or discomfort surrounding your symptoms.

How does a pessary work?

A pessary is like an orthotic for your vagina. They work by providing support to the pelvic organs that may have shifted due to pressure or changes in structural support. 

Pessaries can be worn all the time or if preferred, only during activities that cause symptoms. While a pessary alone doesn’t heal a prolapse, when used alongside physical therapy and strengthening, a pessary can improve outcomes and quality of life. This is because it allows for the pelvic floor muscles to strengthen while your organs sit in a better, supported position.

Pessaries may be used to manage symptoms long term in order to avoid surgery, or might just give you a leg up on your strengthening to help get to a point where you can manage without. Following up with your provider after a year of usage can help determine how long term the need for a pessary might be. 

How do I get fit for a pessary?

We fit for pessaries at Lady Bird PT! Prior to being fit for a pessary, you will first have an initial evaluation with your physical therapist in order to understand your symptoms, determine your baseline, and learn about your needs. During this initial appointment, we will evaluate your abdomen and pelvic floor for baseline strength and tension in order to determine a holistic, whole body approach to treating your symptoms. We’ll also ensure you are an appropriate candidate for this assistive device.

Your fitting will take place at the second visit. Your physical therapist will measure for the appropriate sized pessary digitally with their index and middle finger. Based on this measurement, the PT will insert the size pessary they feel is appropriate. After inserted, you will assess for any symptoms - you should feel nothing once the pessary is inserted. If you have any discomfort or pressure, the pessary is either not in the proper position or the fit is incorrect. As long as there are no symptoms, the PT will have you stand and perform a functional assessment - such as jogging, squatting, running. 

The PT will then remove the pessary and instruct you on how to insert and remove the pessary yourself for management. You will perform self insertion and removal prior to leaving the office so we’re sure you’re confident in using the device independently before you go home that day!

Following your fitting appointment, your PT will see you back in a week to ensure fit is appropriate and there are no concerns with the device. You two will work together to determine the appropriate plan for moving forward.

How do I care for my pessary once I have it?

In order to care for the pessary, it needs to be cleaned with mild soap and warm water daily or every other day. If sterilization is required, boil for 10-15 minutes. 

We recommend removal at night and removal for sex but the pessary can be left in during your period. It is normal to have increased discharge but symptoms that would indicate the need to contact your physician include new onset of bleeding accompanied with fever/chills, foul smells, pain or difficulty with urination, or any pelvic pain or pressure.

Ready to get started?

Lady Bird Physical Therapy specializes in getting to the root of your symptoms in order to help you live your best life now and in the years to come. If you’re ready to work towards feeling stronger, more confident and more comfortable, you can get started today.

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Elizabeth was raised in Houston, Texas and moved to Austin to attend The University of Texas for her undergraduate degree. After completing her undergrad degree in Exercise Science with special focus in medical fitness and rehabilitation and a minor in biology, she moved to Dallas to complete her Doctorate in Physical Therapy at Texas Woman’s University. Following her DPT, she continued her education and completed an optional orthopedic residency at Memorial Hermann Rocket’s Sports Medicine Institute in Houston, Texas. Here, Elizabeth received continued education in orthopedics and sports, completed research, taught at the local PT and PTA programs, and was directly mentored by specialized clinicians in the field. Following her residency program, Elizabeth became an Orthopedic Certified Specialist through the American Board of Physical Therapy Specialties.

Elizabeth’s goal has always been to utilize her specialized knowledge to advocate for a more niche population that incorporates pelvic health. With the hopes to blend her passion and her current skills, Elizabeth has completed a pelvic floor certification and continuing education focusing on pelvic health. Elizabeth prides herself on treating the whole person and loves supplying her patients with all the knowledge, empowerment, and support they need to return to all of their most meaningful activities.

In her free time, you can find Elizabeth trying new workout classes around Austin, lifting weights, scoping out the live music scene, or in the kitchen attempting a new recipe from one of her favorite cook books.