What is a pessary, and why would I need one?

 

​As pelvic floor physical therapists, one of the most common concerns we hear from patients is:

“I feel like something is falling out” or “I can’t stop leaking when I cough or exercise.”

These symptoms are often related to pelvic organ prolapse (POP) or stress urinary incontinence. While these issues are common, they can be frustrating and impact everything from your comfort at rest to your ability to enjoy exercise or intimacy.

The good news? You don’t have to jump straight to surgery. One effective, non-surgical tool we use in pelvic floor physical therapy is the pessary.

 

What is a Pessary?

A pessary is a soft, medical-grade silicone device that’s placed inside the vagina to provide support. Think of it as a small, removable brace for your pelvic organs. By sitting comfortably inside the vagina, a pessary can help lift and support tissues, reduce the sensation of heaviness, and, in some cases, improve bladder control.

​

Types of Ring Pessaries

The ring pessary is one of the most commonly used styles, especially for people with mild to moderate prolapse.

• Ring Pessary (standard) – A flexible ring that supports the vaginal walls and pelvic organs. It can ease the feeling of bulging or heaviness, making daily activities and exercise more comfortable.

• Ring Pessary with a Knob – Has a small extension that rests gently against the urethra. This provides the same support as a standard ring pessary, with the added benefit of helping reduce or stop stress urinary incontinence(leaking with coughing, sneezing, or activity).​​

 

How Pelvic Floor PTs Fit Pessaries

1. Assessment – We’ll talk about your symptoms, medical history, and goals. Then we perform a gentle pelvic exam to assess prolapse, tissue health, and pelvic floor muscle function.

2. Fitting – Pessaries come in many sizes, so we try different fits to find the one that feels comfortable and supportive for your body. You should be able to walk, cough, squat, and move around without feeling the pessary slip or cause discomfort.

3. Education – We teach you how to insert, remove, and clean the pessary if you’d like to manage it yourself. Some patients feel comfortable doing this at home, while others prefer us to handle removal and cleaning at regular visits.

4. Follow-Up – Just like glasses or orthotics, pessaries sometimes need adjustments. We’ll check in regularly to make sure the pessary is still working well, tissues are healthy, and your goals are being met.

​​

Why Combine a Pessary with Pelvic Floor PT?

A pessary provides immediate mechanical support, but pelvic floor therapy addresses the root causes of prolapse and incontinence:

• Strengthening and coordinating pelvic floor muscles

• Improving breathing and core mechanics

• Addressing constipation, pressure management, and lifestyle factors

• Supporting return to exercise, work, and intimacy without fear of leakage or heaviness

This combined approach means you get both short-term relief and long-term improvements.

 

The Bottom Line

If you’re dealing with prolapse or bladder leaks, you don’t have to choose between living with the symptoms or having surgery. A ring pessary — fit by a pelvic floor PT — is a safe, reversible, and effective option that can help you feel supported and in control again.

Every patient’s journey is unique, and as pelvic floor therapists, we’re here to guide you through the process, from fitting to ongoing care, while also helping you strengthen and restore your pelvic floor.

If you’re curious whether a pessary might help you, reach out to us!