Incontinence pessaries are plastic devices, similar to vaginal contraceptive diaphragms, which are used to either lift the bladder or to apply some compression to the urethra during activities that are known to cause leakage. They are successfully used for the treatment of stress urinary incontinence and vaginal or uterine prolapse. They are a low risk treatment option when compared to surgery for symptomatic urinary incontinence. About half of the women who are successfully fitted with a pessary will continue to use it on a long-term basis. Typical incontinence pessary users are women who
- Need temporary help with urine leakage during exercise
- Have mild symptoms and want to avoid surgery for the moment
- Have health problems that make the risks of surgery too great
- Need to delay surgery and are uncomfortable from their incontinence
There are numerous shapes and sizes of pessaries to meet the individual support requirements of different patients. Seeking care from a provider with a wide selection of pessaries may improve the chances of getting a comfortable fitting pessary. Not all women can have their urinary incontinence successfully prevented by a pessary. Situations such as vaginal scarring, a surgically narrowed or shortened vagina or very weak pelvic floor muscles can cause pessaries to fall out or be uncomfortable. Pessaries do require ongoing care to avoid problems with vaginal infection, ulceration or bleeding. A neglected pessary can result in erosions through the vaginal wall into the bladder or rectum.
Because incontinence pessaries often apply some pressure on the urethra to prevent urine leakage, ideally a woman is taught to remove, clean and reinsert her pessary on a regular basis. Frequently, vaginal estrogen cream, tablets or a ring are prescribed to women who use a pessary to strengthen the vaginal skin, especially for those in menopause. This will reduce the risk of developing a vaginal skin erosion or ulceration. Incontinence pessaries are not appropriate for women who cannot care for them.
Original publication date: May 2008; Content Update: July 2013