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Pessaries: A Modern Tool for Treating Prolapse and Incontinence
Pessaries have come a long way from their ancient origins. Today, they're sleek, medical-grade silicone devices that can help with prolapse and stress incontinence, no surgery required. In this episode, I break down the different types of pessaries, how they work, and why they're not just for "frail grandmothers" anymore.
We'll cover:
• How pessaries support prolapse & stress incontinence
• Over-the-counter options like Poise Impressa, Uresta, Revive
• Custom-fitted pessaries & innovative 3D-printed options from Cosm
• When pessaries are a bridge to surgery (and when they're the long-term fix)
Bladder Support for Women | Uresta
FemTherapeutics - Pessary for prolapse support
Personalized Pessaries for Pelvic Floor Disorders | Cosm Medical
Revive Reusable Bladder Support for Women – Leak Protection & Comfort
Timeline:
00:30 Introduction to Pessaries
00:51 History and Evolution of Pessaries
01:51 Modern Pessaries: Materials and Misconceptions
02:29 Benefits and Flexibility of Pessary Use
02:55 Pessaries as a Temporary or Permanent Solution
04:28 Candidates for Pessary Use
06:02 Pessaries for Prolapse 08:22 Pessaries for Incontinence
11:35 Potential Risks and Side Effects
12:19 How to Get a Pessary
12:45 Conclusion and Encouragement
Hi there. I'm gonna take some time today and talk to you about pessaries. In urogynecology, we use pessaries to treat vaginal or uterine prolapse, and we use them to treat urinary incontinence or bladder leaking. In general, there are two different types of pessaries. One to treat, prolapse and the other for bladder leaking.
The word pessary comes from the ancient Greek word pestos, meaning a round stone for games. This word became the late Latin pe, which meant a medicated tampon. The word pessary was first used in the 15th century to describe a medical plug that fit inside an orifice in the body. We now use the word pessary to describe a medical device that fits in the vagina to treat prolapse or urinary incontinence, or both.
Pessaries have been around for a long time and they have been described in writings all the way back to ancient Egypt. They have also been described in Greek medical. These initial pessaries often involved using a fruit or a vegetable or a part of the fruit or vegetable. We don't do that anymore for clear reasons.
In the 16th century, there was the first manmade pessary and it was made from brass and waxed cork. Things have changed over time, and pessaries now are generally made from medical grade silicone. The only one that I know of with another component is a SIG use Impresa, which is silicone in the middle, surrounded by a polypropylene material.
When I talk to my patients about pessaries, most of them aren't interested. Some women correlate a pessary with an older, frail relative or maybe their mother, and they don't like to think of themselves like that. Some people have never heard of a pessary, but I personally love the idea of a pessary, and here's why.
A pessary is just one more tool to help you treat your leaking or prolapse. There's little risk associated with it. You can use it all the time, or you can use it just when you. If you only wanna use it on Tuesdays during a workout class, that is perfectly fine. If you only wanna wear it when you travel, that too is okay.
If you wanna wear it every day, that works. A pessary can be a permanent treatment for some women. That's all they do to treat their prolapse. Or it can be a bridge to surgery. So what do I mean by that? Let's say you're really bothered by your prolapse and you're interested in surgery, but it's October and you really don't have the time for surgery because of your family and your job until the summer.
You could use a pessary to keep you more comfortable while you're waiting for the surgery. Or you can use the pessary to give you more time to think about the options and think about what you wanna do. I also use a lot of pessaries in women who recently delivered and have a bothersome prolapse. The months after a delivery are a time of intense healing in the pelvic floor.
Muscle and nerve function is often abnormal after a delivery, but the function will improve as things heal and return in the months after the delivery. Depending on how difficult the delivery was and how much trauma there was, it can take six months or even 12 months for this healing to occur. This is a horrible time to have surgery because things may still improve.
Prolapse can actually resolve itself in this timeframe, and generally we want to wait until the maximal amount of function is restored. Taking care of a new baby with prolapse is hard and a pessary can be the perfect solution. So who is a good candidate for pessary? Okay. All women who have a prolapse or stress incontinence should be offered a prolapse.
They don't have to try it. It's up to them, but they should know that it is a treatment option. A pessary won't work for urge incontinence, so it's important that you know that you have stress incontinence and not urge. It will also treat the stress component of mixed ary incontinence. I also think that pessaries tend to work poorly for erectus seal.
Erectus seal is often quite low in the vagina and a pessary sits higher and doesn't always support it well. All other types of vaginal prolapse and stress urinary incontinence should be offered a pessary. So who is a poor candidate for pessary? In my experience, if you're someone who doesn't like tampons and never really has worn them, you won't like a pessary.
If you're someone that has pelvic pain, you may find a pessary to be more uncomfortable, and so this would be a poor choice for you. If you're someone who has had pelvic radiation, a pessary is likely to be more uncomfortable or not fit quite right. If you have skin conditions like lichen sclerosis, then putting the pessary in and out can be quite uncomfortable.
And then if you have other medical problems, like a pelvic cancer that's not treated, a pessary is not a great option for you. So let's talk about pessaries for prolapse. Right now in the United States, all of the available pessaries that treat prolapse involve having a, an appointment with a provider.
They come in different shapes, they come in different sizes, and you need to be fitted to make sure that you have a pessary that will work for you in Oregon. Pessaries can be prescribed by a physician's associate, a nurse practitioner, or a physical therapist. A correctly fitting pessary should stay in place and you won't feel that it is there.
But this is also where things can go wrong. Sometimes a pessary might pop out when you don't want it to, and for some women it can be a little uncomfortable. In most circumstances, you'll learn to place and remove the pessary. The most common type of pessary for uterine or vaginal prolapse is a ring with support.
So this particular pessary is shaped like a ring, and then there's a membrane in the center of the ring. This one is the easiest one to place and to remove. There are also many different sizes of each pessary, and there are many different shapes. Some of the other shapes include a dish with support that's similar to the ring, but a little bit bulkier.
There's agel horn and that's a pessary that I think looks like a mushroom with a prominent stock. There are also cubes and donuts that look exactly like they are named. There are a whole bunch more, and so a pessary fitting appointment can take quite a bit of time to make sure that you have the right one.
Cosm, COS m.care. Has created tics, pessaries, and these pessaries are 3D printed to create a pessary that is specifically designed for a patient. So if the measurements of our standard pessaries just don't work, you can make one that is specifically designed. These are currently cleared for sale in the United States, but I'm not sure if they're actually being sold quite yet.
Femme Therapeutics is making an over the counter pessary. That is dispo disposable. This is a pessary that you put in the vagina and then you inflate it. It has an applicator. It also has a withdrawal tab. You can use it for up to 14 days, and then when you're removing it, you deflate it to remove it. This is going to be available in 2026 and is not currently a for incontinence pessaries.
There are two choices. The first one is to get fitted for one by a provider and the other is to get one that is over the counter. Traditional incontinence, pessaries are silicone. They have a knob on them that sits underneath the urethra to provide some additional pressure, and they come in the ring shape or the dish shape.
Again, there are many different sizes. You will be taught to put it in and to take it out. And these medical grade PEs pessary is last for more than a year. A newer incontinence Pessary is the Yani fit, and this one looks more like a menstrual cup. It comes in multiple sizes, and you would also get this one through a provider.
For some women, they're more interested in doing this on their own, and they're not interested in seeing a physician and going through the whole fitting appointment. The first over the counter pessary for incontinence was the Impresa I-M-P-R-E-S-S-A, and that was made by poise. The Impresa is a single use you once you take it out, you dispose of it.
It works well. But a lot of women find it to be too expensive for long-term use, and some of the women find that the fabric that's over the silicone can be a small bit chafing and irritating.
The UTA is another over the counter pessary that has been available over the counter just since 2025. So earlier this year. It has been available over the counter in Canada for much longer. The arrest is available in five sizes, and when you order your first kit, which is a fitting kit, they send you the three middle sizes and you decide which one is the most comfortable and works the best for you.
If one of those three middle sizes does not work, you can get one that is the biggest. Or you can get one that is the smallest. There's also the revive over the counter pessary. This can be used for up to 12 hours and you can reuse it and you would replace it monthly. So if you use it daily, then you would replace it monthly.
If you use it less frequently, then you would replace it less, frankly, less frequently, and it is placed inside. Or inserted much like a tampon. So those are your pessary choices for prolapse and for incontinence. Pessary is very low risk. You can have some vaginal discomfort or irritation. You can get a little bit of spotting or bleeding, and if that happens, that always needs to be evaluated.
It can create a little bit of skin trauma. That's what the bleeding is from, but you wanna make sure that's what's causing it and something else isn't going on. You can get increased discharge with it. And rarely a pessary may work so well that you would not be able to empty your bladder, so then you would have to take it out so that you could empty your bladder.
If you have any symptoms, you should see a provider. It's hard to know if it's from the pessary or something else, and so you want that to be evaluated. If you're interested in a pessary, u GYNs all have pessaries. Some gynecology offices do as well. Some urology offices do as well, and some family practice offices do as well.
If you're interested in trying a pessary, I would tell you to start with your primary care doctor, and if they don't have it, then ask them who you might see to be fitted for a pessary. So I hope you found this to be helpful. I really think that Pessaries need to be rebranded. They're so useful and helpful for women.
They can help you not leak when you're exercising. They can hold up your prolapse while you're exercising. They can help you to travel. They could help you to hike. They're just one more tool for you to have in your toolbox to treat your. Pelvic floor issues. It doesn't mean that you're frail or you're old, it just means that you are actively doing something about a symptom that bothers you and you're not really interested in surgery at that point in time.
And I think it's important to have more non-surgical options. I'll put links to the different products that I mentioned in the show notes. If you're interested in them, you can find them there. So I will put them for cosm, for Esta for Fem Therapeutic, the Revive and the Yani fit. Sometimes I think going to these links and getting some visuals can be really helpful for women.
And you know, with Pessaries, I would say go ahead and try it. You might just like it.
