Pessaries and Pelvic Floor Therapy
A Conservative Option Worth Understanding in Pelvic Health
For patients managing pelvic organ prolapse—where the bladder, uterus, or rectum descends from its normal position—a vaginal pessary can be a valuable part of a conservative management plan. These medical-grade silicone devices are fitted internally to provide structural support to prolapsed organs and can also help reduce stress urinary incontinence by supporting the urethra.
Pessaries and Pelvic Organ Prolapse
Pessaries are commonly offered by clinicians as a first-line treatment for prolapse, particularly for patients who wish to delay or avoid surgery, are planning future pregnancies, or have medical contraindications to operative treatment. Pelvic organ prolapse affects roughly 40% of women over age 40, with prevalence expected to increase as the population ages. Pessaries can be used across all stages of prolapse and are suited to a wide range of patients—from younger individuals managing postpartum changes to older adults with comorbidities seeking effective, reversible relief.
Personalized Treatment Works Best
Evidence on how pessaries compare to or combine with pelvic floor muscle training (PFMT) is still developing. A Cochrane review found that at 12 months follow-up, it remains uncertain whether there is a meaningful difference between pessaries and PFMT in terms of women’s perceived improvement in prolapse symptoms or prolapse-specific quality of life, based on currently available trials. What is well established is that PFMT protocols show measurable improvements in prolapse symptoms, pelvic floor function, and quality of life on their own. In practice, this supports an individualized approach: for many patients, a pessary providing mechanical support alongside a structured PFMT program addresses both the structural and neuromuscular contributors to prolapse and incontinence.
Pessary Ring Fitting
Fitting typically begins in clinic, with a trial period to assess comfort and fit before committing to a device. Many patients, once properly sized, are able to independently insert, remove, and clean their pessary, reducing the need for frequent follow-up visits. Periodic check-ins and, when appropriate, topical estrogen can help maintain vaginal tissue health and minimize irritation with long-term use.
Pessaries remain a clinically relevant, evidence-based option—conservative, effective, and reversible—whether used independently or as part of a broader pelvic floor rehabilitation program.
References
- Bugge C, Adams EJ, Gopinath D, et al. Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database Syst Rev. 2020;(11):CD004010.
- Pessaries for Managing Pelvic Organ Prolapse in Women. American Family Physician. 2021;103(11):660-661.
- Espiño-Albela A, Castaño-García C, Díaz-Mohedo E, et al. Effects of Pelvic-Floor Muscle Training in Patients with Pelvic Organ Prolapse Approached with Surgery vs. Conservative Treatment: A Systematic Review. J Pers Med. 2022;12(5).
