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Pessary for treating stress incontinence

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What is stress urinary incontinence (SUI)?

SUI happens when your bladder leaks urine during physical activity. It may range from leaking a few drops of urine to completely emptying your bladder. You may have leakage when you:

  • Sneeze
  • Cough
  • Laugh
  • Bend over
  • Rise from a chair
  • Walk
  • Run
  • Exercise

What are risk factors for SUI?

There can be many causes.  Often there is more than one cause.  

  • Pregnancy and vaginal childbirth
  • Obesity
  • Pelvic floor disorders
  • Lifting heavy objects
  • Frequent straining/constipation

How is SUI diagnosed?

Your provider will take your medical history and do an exam.

What are treatment choices?

Loss of bladder control is a common problem. There are many ways to treat it. So, talk with your provider if you have symptoms that are bothersome.

You may be offered:

  • Lifestyle changes
  • Pelvic floor muscle exercises
  • Physical therapy
  • Pessary
  • Surgery

What is a pessary?

It is a device that is placed up in your vagina to help support the walls of your vagina, bladder, and urethra. It can be used to treat SUI.

Pessaries come in many shapes and sizes. Your provider will:

  • Talk with you about the type that will work best for you
  • Fit you with the correct pessary
  • Teach you how to care for it

How do I place the pessary?

  1. Moisten the pessary with water or a small amount of lubricant.
  2. Fold it with the dominant hand (the hand you use the most).
  3. While sitting or standing, spread your labia with your non-dominant hand (your other hand).
  4. Gently put the folded pessary into the vagina.
  5. When it is halfway into the vagina, while you are still holding the folded pessary, move your non-dominant hand to help guide and push it into the vagina.
  6. After it is in the vagina and you let go, it will unfold.
  7. Gently push it back as far as it can go. You cannot push it back too far.
    • It should not cause discomfort while in place.

If your provider wants you to use vaginal estrogen, you can do either of the following:

  • Put estrogen cream or estrogen tablet into the vagina at night after taking out the pessary. You often do this 2 times per week.
  • Use 2 pea sized dabs of estrogen cream when you put in your pessary.

How do I manage the pessary?

Take it out and leave it out at night at least 1 time a week. Some people take it out nightly. Then they put it in the next morning.

To remove the pessary:

  1. Place your index finger and thumb into vagina and get a hold of it. You may need to bear down to get a hold of it.
  2. Gently pull it out.
  3. Clean it with mild soap and water. Let it air dry.
  4. Check it for:
    • Cracks
    • Tears
    • Changes in color

Additional general questions

If the pessary comes out, you may reinsert it.

  • This may happen with a bowel movement.
  • Do not flush it.

If the pessary is uncomfortable, you may take it out.

You can reinsert it right away or leave it out for hours.

Remember to push the pessary back as far as you can get it. You cannot push it in too far.

Most devices are uncomfortable if left in place during sexual activity.

It is best to remove it unless told differently.

Vaginal discharge is very common when using a pessary.

When should I call the clinic?

Call to be seen if you have:

  • Chills and/or a fever over 100.4° F (or 38° C)
  • Vaginal pain
  • Bloody discharge when taking out the pessary
  • Foul smelling vaginal discharge
  • Irritation from the pessary that does not get better
  • Any vaginal bleeding not related to your period
  • Tears, cracks or changes in the color of the pessary
  • If you cannot get the pessary in or out
    • This is not an emergency, call the clinic when it is open.
  • If you lose the pessary