Pessary Fitting & Management

A pessary is a soft, removable device placed in the vagina to support pelvic organs that have started to descend, or to add support beneath the bladder neck to help reduce certain types of leakage. It is one of the oldest and most consistently used tools in pelvic health care, and for many people it offers meaningful day-to-day relief without surgery, either as a long-term strategy or as a bridge while other approaches, like physiotherapy, take effect.

What a Pessary Is and How It Works

Once positioned, a pessary sits within the vaginal canal, held in place by the surrounding vaginal walls and the muscular sling of the levator ani group. It works mechanically: its shape and firmness resist the downward pressure that pushes the bladder, uterus, or rectum toward or through the vaginal opening, in effect standing in for some of the structural support that connective tissue and muscle would otherwise provide. Certain pessary designs also press gently against the tissue beneath the urethra, adding support that can help reduce leakage with coughing, laughing, or exercise in a way that is mechanically similar to how the body’s own supportive tissue normally backs the urethra during a rise in abdominal pressure.

Why Mechanical Support Helps Prolapse and Some Leakage

The pelvic organs are held in position by a combination of the levator ani muscles, which form a muscular floor, and the endopelvic fascia and ligaments, which act more like suspensory tissue. When either the muscle or the connective tissue loses tone or tensile strength — through vaginal childbirth, chronic straining, connective tissue changes around menopause, or a combination of these — the organs can descend lower than usual, producing a sensation of bulging, heaviness, or pressure, especially by the end of the day or after standing and lifting. A pessary does not repair the underlying tissue, but by taking over the mechanical job of holding organs in a more typical position, it very often meaningfully eases those symptoms while it is in place. For stress incontinence, a similar logic applies: some leakage happens because the urethra no longer has firm enough support beneath it to stay closed under pressure, and a pessary with a knob or support arm can supply that support externally.

Who a Pessary Can Help

• Pelvic organ prolapse — for bulge, heaviness, or dragging sensations, particularly for those who want to avoid or delay surgery.
• Stress urinary incontinence — particularly leakage tied to specific activities like running, jumping, or heavy lifting.
• Postpartum recovery — temporary support while pelvic floor strength and connective tissue recover after childbirth.
• Those planning future pregnancy — as a non-surgical option that does not affect future delivery options the way some surgical repairs might.
• People with higher surgical risk or who prefer to avoid surgery — a pessary can offer symptom relief without an operation or anesthesia.
• As a bridge during physiotherapy — providing day-to-day comfort and support while pelvic floor muscle training builds strength and coordination over time.

The Individualized Fitting Process

Fitting a pessary is a hands-on, trial-based process rather than a single measurement. After discussing your history, symptoms, and goals, an internal examination helps assess vaginal length, width, tissue quality, and the specific pattern of any prolapse; this examination is explained step by step in advance and proceeds only with your ongoing consent. From there, we trial different pessary shapes and sizes directly, checking that the device stays comfortably in place through movements like coughing, bearing down, and squatting, and that it does not cause pressure or discomfort. Before you leave, we confirm that you can urinate normally with the pessary in place, since an incorrectly sized device can occasionally interfere with bladder emptying. It is common to need one or two follow-up visits to fine-tune size or style once you have worn it through normal daily activity.

Common Pessary Styles

• Ring pessary — a flexible ring that supports mild to moderate prolapse and is often straightforward for people to remove and reinsert themselves.
• Ring with support or knob — adds a raised section that presses beneath the urethra, used when stress leakage is part of the picture.
• Gellhorn pessary — a stemmed, disc-shaped device generally used for more significant prolapse, typically managed with clinician-scheduled removal and reinsertion.
• Cube pessary — uses gentle suction against the vaginal walls, useful when tissue support is more limited, and is removed daily.
• Donut or inflatable pessary — a larger supportive ring shape sometimes used for more advanced prolapse or a shorter vaginal canal.

Self-Care, Cleaning, and Follow-Up

Many people learn to remove, clean, and reinsert their own pessary, typically taking it out at night or a few times a week to wash it with mild soap and water. For some styles, or for people who prefer not to manage it themselves, we schedule regular in-clinic removal, cleaning, and reinsertion instead, usually every three to six months. Either way, we check in periodically for vaginal wall irritation, discharge, or discomfort, since tissue can occasionally need a rest period or a size adjustment over time. Because thinner, less elastic vaginal tissue — common during the menopause transition — can make a pessary more prone to irritation, your physician may also recommend local vaginal estrogen to support tissue health, which can work well alongside pessary use.

Working Alongside Your Medical Team

Pessary fitting and management is provided in coordination with, not instead of, care from your family doctor or gynecologist. Some people use a pessary as their main strategy for years; others use it temporarily while considering surgical options or while building strength through pelvic floor physiotherapy. If your prolapse or incontinence changes, or if surgery becomes something you want to explore, we will help coordinate that conversation with your physician. To find out whether a pessary suits your situation, you are welcome to book an assessment at our High Park, Toronto clinic.