A pessary is an intravaginal device made of surgical grade silicone for the use of internal pelvic support. A pessary is a valuable tool for us to help in the management of incontinence and pelvic organ prolapse. Historically they have been a tool used mostly by gynaecologists, but in more recent years pelvic health physiotherapists have taken on a significant role in fitting and managing these devices.

A pessary is not a device you can order for yourself as there are many many shapes and sizes to choose from. The shape (or type) of a pessary is very much determined by your presentation; a pessary used for stress incontinence will be very different to a pessary used for apical or uterine prolapse. Not only does the shape or type of pessary need to be appropriately chosen, but they also need to be specifically fitted to you. Each shape of pessary comes in a variety of sizes, sometimes there can be 10 or even 12 sizes to be chosen from.

We also have different ways of managing different pessaries. Many pessaries can be placed and removed by you, and if so, your physiotherapist will train you in how to do this safely. This means some can be used just during the activity of concern, e.g. while going for a run or trampolining with the kids. Some just get removed twice a week for cleaning. 

If you’re concerned that you won't be able to insert and remove a pessary yourself, they can be managed by the physiotherapist. Some pessaries cannot be removed without a practitioner, and for these ones, you will also have this managed by your physiotherapist.

If you are self-managing your pessary a typical appointment structure is:

• Initial appointment to appropriately diagnose and start your rehab program. These are usually 60 mins. This is where a pessary may be suggested and discussed.
• Pessary fitting: minimum 45mins where we can trial a variety of sizes. We will fit an appropriate pessary, teach you to remove and replace the pessary if you are self-managing, and you will leave with your pessary at this appointment
• Follow up for 30-45 mins at 2 weeks. This is to ensure the pessary is fitting well, the vaginal walls are tolerating the pessary, and to address any concerns on insertion and removal. Frequently you are on a rehab program also, and this can be worked into the follow up at the same time.
• Follow up after this will be 4 weeks (6 weeks after the initial fitting) for a final check. If everything is going well, you will only need to follow up every 12 months after the initial fitting.
• Annual follow up: at the annual follow-ups, we will check the size of the pessary is still correct. Frequently people may change down a size after the first year. Each year we will recheck the vaginal walls to ensure appropriate fit and replace the pessary device, as per the manufacturer's warranty.  

If you would prefer to have the physio manage your pessary, a typical appointment structure is 

• Initial appointment to appropriately diagnose and start your rehab program. These are usually 60 mins. This is where a pessary may be suggested and discussed.
• Pessary fitting: minimum 45mins where we can trial a variety of sizes. We will fit an appropriate pessary, teach you to remove and replace the pessary if you are self-managing, and you will leave with your pessary at this appointment
• Follow up for 30-45 mins at 2 weeks. This is to ensure the pessary is fitting well, the vaginal walls are tolerating the pessary, and to address any concerns on insertion and removal. Frequently you are on a rehab program also, and this can be worked into the follow up at the same time.
• Follow up after this will be every 3 months to remove the pessary, and check the vaginal walls are tolerating the pessary. If they aren’t tolerating the pessary, we will remove the device and refit it after a week to give the walls a rest.
• Every 12 months we will replace the device, as per the manufacturer's warranty.

Whether you are self-managing or physio-managing the pessary device, you will likely have a rehab program running initially at the same time. These appointments will be worked in together to reduce the number of sessions you need to attend.

Please note: if you are wanting to order a device for yourself, “Contiform” is available to purchase through our website and can be used without physio input, if desired.

A pessary is a wonderful adjunct to pelvic health physiotherapy treatment. They provide us with an option to support the pelvic organs internally. This can help with presentations such as urinary incontinence (stress incontinence, urge incontinence), pelvic organ prolapse, and sometimes simply for recovery after childbirth. 

Not everyone with these presentations needs a pessary though. They are intended to be used specifically and selectively to fit with a woman's presentation, concerns, and to work in with her lifestyle. As such they need to be fitted by a professional, usually a gynaecologist, GP, or womens or pelvic health physiotherapist.

Frequently they are a nice option for women to avoid surgical interventions to manage their symptoms. Or a temporary option for someone who perhaps wants surgical intervention, but has been advised to wait for this until they are sure they have completed their family, and anticipate no further pregnancies.