What Is A Pessary? By Dr. Hailey Jackson

What is a pessary? 

A pessary is a medical device prescribed and fitted to an individual with the goal of supporting the pelvic organs or eliminating stress urinary incontinence. I like to say it’s similar to a sports bra; they come in different shapes and sizes and provide a little extra support. Additionally, like sports bras, each person has a little different preference when it comes to fit and size.  The most commonly fitted pessaries include rings and cubes each of which comes in different sizes and variations. Pessaries are similar to a prosthetic, and that they have to be sized and fitted to each person according to the goals of the individual.

What is a pessary often prescribed for? 

Pessaries are most often prescribed for pelvic organ prolapse and/or stress urinary incontinence. Other countries are beginning to use them postpartum to help with the healing process after birth.

Who can fit a pessary? 

In the United States, OB/GYN’s, Urogyn’s, and pelvic floor physical therapists with further training in pessaries are able to fit pessaries. 

Does it have to be left in all the time?

The goals and reason for using a pessary will determine frequency and duration of insertion of the pessary. Some only choose to insert the pessary during exercise (if that is when they are experiencing symptoms related to prolapse or stress incontinence) while some will leave it in during all of their waking hours. A provider will be able to navigate this decision with you based on your goals. 

Who should not be prescribed a pessary? 

Perhaps a more important question than who would benefit from a pessary is who should not have a pessary? There is a good amount of dexterity required for insertion and removal of a pessary. Therefore, individuals without good dexterity should not be prescribed a pessary. Additionally, those who have undergone previous pelvic surgery with mesh are unable to use a pessary. Lastly, tissue with adequate estrogen in the pelvic floor muscles is required therefore those without adequate estrogen are not recommended to utilize until estrogen is restored.  

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