Pessaries for Stress Urinary Incontinence: What They're For and Who They Help

For many women, stress urinary incontinence (SUI) — leaking urine during activities like coughing, sneezing, laughing, or exercise — doesn't necessarily mean surgery is the next step. A pessary is a removable device that can offer meaningful relief for the right candidates, without the recovery time or risks of an operation. This guide, based on the 2024 Canadian Urological Association (CUA) guideline on female stress urinary incontinence, looks at who pessaries tend to work well for, how effective they are, and what to expect.

This article is for general information only and isn't a substitute for advice from your doctor or a pelvic health specialist. Whether a pessary is right for you depends on your specific situation, so please consult a healthcare professional before starting or changing any treatment.

What Is a Pessary?

A pessary is a removable intravaginal device that helps support the bladder neck and urethra, reducing leakage during physical exertion. Pessaries are one of a few intravaginal device options for SUI, alongside incontinence tampons and intravaginal bladder support devices. You can browse the pessaries available at CanMedDirect.ca.

Who Is a Good Candidate for a Pessary?

According to the guideline, potential candidates for intravaginal devices like pessaries include:

• Pregnant patients, who may want to avoid more invasive treatment during pregnancy.
• Elderly women for whom surgery would carry more risk.
• Women with primary or recurrent SUI who wish to avoid surgery, or avoid repeating a previous surgery.
• Women who only leak in predictable circumstances, such as during strenuous exercise.

To use a pessary, a woman generally needs good hand control, memory, and mental function to insert, remove, and care for the device herself, though some women have it managed by a healthcare provider instead. Because there are tradeoffs involved with any treatment choice, patient values and preferences play a significant role in whether a pessary is the right fit.

How Effective Are Pessaries for SUI?

Clinical evidence summarized in the guideline supports pessaries as a safe and effective option for suitable candidates, with most women who are properly fitted able to wear one comfortably and see improvement in their symptoms. Complications tend to be uncommon, and issues that do come up — such as vaginal discharge, odor, or erosion — can usually be managed successfully by a healthcare provider.

Based on this evidence, the guideline recommends that physicians offer pessaries and other vaginal devices as a safe and effective treatment to women who may be good candidates. That said, individual results vary, and your provider is best placed to set expectations for your specific situation.

What to Expect: Fitting and Care

A pessary needs to be properly fitted by a healthcare provider to find the right size and shape for your anatomy. Once fitted, ongoing care typically involves:

• Regular removal and cleaning, on a schedule your provider recommends.
• Periodic follow-up visits to check for irritation or fit issues, especially early on.
• Watching for symptoms like unusual discharge, odor, discomfort, or bleeding, and reporting these to your provider.

If self-care of the pessary isn't manageable, some women have it removed and reinserted periodically by a healthcare provider instead.

How Pessaries Fit Into the Bigger Picture

Pessaries are one of several non-surgical options for SUI. Others include supervised pelvic floor muscle training (the guideline's recommended first-line treatment), weight management, and lifestyle adjustments. Some women use a pessary alongside these other approaches rather than instead of them — your provider can help figure out what combination makes sense for you.

When to Talk to a Doctor

It's worth seeking a medical evaluation before starting a pessary, and promptly if you're already using one and notice:

• Blood in your urine, or new pelvic pain
• Persistent discharge, odor, or discomfort with the device
• Difficulty inserting, removing, or tolerating the pessary
• Symptoms that aren't improving despite consistent use

Ready to explore your options? View the full selection of pessaries at CanMedDirect.ca.

Reminder: this article provides general information and is not a substitute for professional medical advice. Please consult your doctor or a pelvic health specialist to determine whether a pessary is appropriate for your specific situation.