Originally published on July 9, 2026 by Vital Physiotherapy & Wellness, now part of the Bravella Health network. Original author: Julie Bagshaw.
As a pelvic floor physiotherapist, two of the most common conditions I encounter in my day are pelvic organ prolapse (descent of 1 or more pelvic organs into the vaginal space) and stress urinary incontinence (leaking with coughing, sneezing, laughing, exercises). Pelvic organ prolapse (or POP) is identified anatomically in ~50% of adult females, with only 6% reporting complaint of symptoms.[1] Stress urinary incontinence (or SUI) is reported in as many as 38% of women who are assigned female at birth.[2]
What Is a Pessary and How Does It Help POP and SUI?
A pessary is a medical device made typically of silicone that is inserted into the vagina to support the vaginal walls and corresponding pelvic organs (bladder, uterus, rectum) to help reduce common symptoms of prolapse such as pelvic heaviness/pressure or a feeling of a bulge at the vaginal opening and can provide gentle pressure on the urethra to reduce or eliminate stress urinary incontinence.[3]
In the past, pessaries were considered more of a last step of conservative management for POP and SUI, however the Society of Obstetricians and Gynaecologists of Canada clinical practice guideline on pessary use is now encouraging that pessaries should be considered in “all women presenting with bothersome pelvic organ prolapse symptoms and/or stress urinary incontinence” regardless of age.[3]
How Do You Get a Pessary?
In Ontario, there are several options to complete a pessary fitting appointment. A family doctor can provide you with a referral to a specialist (e.g. gynecologist, urogynecologist) who can fit you and provide ongoing care. Another option would be to see a trained pelvic floor physiotherapist for a pessary fitting. This service would come at a cost, however wait times should be much faster. At Vital, we are now providing ongoing management of clients who already have a pessary and several of our physiotherapists are performing pessary fittings at clinics within Toronto.
What to Expect at a Pessary Fitting Appointment with a Pelvic Physiotherapist
Similar to a typical pelvic floor initial assessment, your therapist will take a detailed history of your symptoms, lifestyle, sexual activity and goals. With consent, a pelvic exam is performed to assess the type and degree of prolapse and to assess your current muscle tone and strength.
If there are no contraindications to using a pessary, typically 1-3 sizes of pessaries will be tried to find the best fit. A well-fitting pessary should feel comfortable, stay in place with movement and not interfere with urination or bowel movements. You might be asked to perform a series of postures and activities (e.g. bend down to pick up something from the floor), to cough or to bear down to ensure the pessary stays in place.[3]
If a good fit is found, you can then purchase this pessary to take home and use. You will be educated on topics such as how to remove and insert your pessary (if you are able to do this on your own), how to clean it and potential risks to monitor for. The most common side effect of pessary use is an increase in vaginal secretions.[3] Typically, you will return 2 weeks after to ensure the pessary continues to fit well and the tissue in the vagina is tolerating use of the pessary.
How Do I Care for My Pessary After My Fitting?
There are two models of pessary care: self-managed and clinic-managed. Depending on the type of pessary, you may be required to remove it daily while others can stay in place (some even during intercourse!) for up to 3 months.[3]
If you are able to manage pessary removal and cleaning on your own at home, in your first year of pessary use it is recommended that you visit your OB/GP or pelvic physiotherapist after 3 months and after 9 months for an examination of your vaginal tissues, review of symptoms and to troubleshoot any concerns. After the first year of using a pessary, it is advised that 1x/year you visit your OB/GP or pelvic physiotherapist for a check that your vaginal tissues are handling pessary wearing well.[3]
If you are NOT able to insert and remove your pessary for cleaning, you are advised to see your fitting provider or pelvic floor physiotherapist every 3 months while you are using your pessary to remove, clean, check your vaginal tissues and re-insert the pessary.[3]
In the first 6 months of pessary use, it’s common to stop use of the pessary due to the pessary falling out, difficulty with insertion/removal, increased discharge or infection. Regular check-ins with a trained pessary care provider can help you to troubleshoot these concerns and make sure that your body is tolerating use of the pessary, particularly if it’s worn daily.[3]
A successfully fitted pessary ideally is not felt by the wearer or cause any discomfort, it resolves bothersome symptoms of pressure, heaviness or leaking and does not interfere with emptying of the bladder or rectum. This tool can be a helpful adjunct to your current pelvic floor physiotherapy exercises and a great way to manage these bothersome symptoms.
For more information on Vital’s new pessary management services, please reach out to us at info@bravellahealth.com or 416-551-0900.
References
- McLeod LJ, Lee PE. Pelvic organ prolapse. CMAJ. 2023;195(30):E1013. doi:10.1503/cmaj.230089
- Patel UJ, Godecker AL, Giles DL, Brown HW. Updated prevalence of urinary incontinence in women: 2015–2018 national population-based survey data. Female Pelvic Med Reconstr Surg. 2022;28(4):181-187. doi:10.1097/SPV.0000000000001127
- Harvey MA, Lemieux MC, Robert M, Schulz JA. Guideline No. 411: vaginal pessary use. J Obstet Gynaecol Can. 2021;43(2):255-266.e1. doi:10.1016/j.jogc.2020.11.013
