Pessary Clinic

About Pessaries

What is a pessary?

A pessary in a medical device worn intravaginally to provide support for the pelvic organs and symptomatic relief from urinary incontinence and pelvic organ prolapse.  You can think of it like a sports bra for your vaginal walls & pelvic organs.

Intra-WHAT?! You want me to put it where?!

Yep! A pessary is inserted into your vagina. Just like a tampon or menstrual cup, once it’s in place, you typically can’t even feel it but it will provide support where you need it.

Who is a pessary for?

A pessary can be a great choice for individuals experiencing:

• urinary leaking during sneezing, coughing, daily activities, or exercise
• pelvic organ prolapse (symptoms may include: sensation of a vaginal bulge or visibly seeing tissue bulging towards or past the vaginal entrance, pelvic pressure or heaviness, difficulty fully emptying bladder or bowel, low back pain)
• significant laxity within the pelvic support system in the absence of symptoms

Not sure if a pessary is right for you?  A pelvic health assessment can be a great place to start. Your pelvic physiotherapist can review your symptoms and provide a pelvic examination to help determine if you’re a good candidate for a pessary.

WHEN would someone wear a pessary?

It depends! Pessary use can vary from person to person.

Here are some hypothetical examples:

• Rachel has leaking that only occurs when she runs, which is an activity that’s very important to her. She only wears her pessary when she runs. The pessary provides just enough support that she can run leak-free. She pops it in before hitting the trail and then takes it out when she returns home.
• Shilpa has prolapse symptoms throughout the day when she carries her baby, lifts her toddler, and completes her daily tasks. She prefers to wear her pessary daily, putting it in each morning and removing it each night.
• Helen has a significant prolapse that interferes with her ability to empty her bladder and creates a persistent & bothersome bulging sensation. She opts to wear her pessary continuously under the direction of her physician who she sees once every 3 months to remove & clean the pessary, check her vaginal tissues, and reinsert it.

Who is a pessary NOT for?

A pessary is NOT a good choice for anyone experiencing:

• An active wound or abrasion of the vaginal tissues (this would need to be resolved before a pessary fitting can occur)
• Significant genitourinary syndrome of menopause (GSM) who is also NOT willing to use vaginal estrogen
• Significant cognitive decline or mobility limitations that would interfere with appropriate pessary self management and/or adequate follow-up

We require a physician referral for initial pessary fittings. This helps to keep your doctor in the loop so that we may provide collaborative care, and also helps to avoid disappointment if you’re not appropriate for a pessary fitting at this time. The referral form can be found here: Pessary Referral Form – RX Physiotherapy.

What types of pessaries are available?

Your pelvic physiotherapist will determine what type and size of pessary is appropriate for you based on your symptoms, preferences, and anatomical factors. During the initial fitting, we typically trial 1-3 different pessaries.

RX Physiotherapy carries an assortment of pessary sizes and types to suit the vast majority of individual needs:

• Rings (with and without support)
• Cubes
• Incontinence dishes with knob
• Gelhorns
• Marlands

If we need to consider a pessary type beyond those listed above, we can order in additional options if appropriate for you.

What if my pessary fitting is not successful?

Pessary fitting is an art and a bit of trial and error can be involved in finding the absolute best pessary for YOU.  When a pessary is well-fitting, it’s comfortable, stays in place, and either resolves or significantly reduces the symptoms it’s being used for. 

If a pessary is too small for you or not the right type, it can slip down, fall out, or fail to improve your symptoms.

If a pessary is too large for you, it can cause discomfort and may interfere with your ability to empty your bladder.  During your fitting appointment, we ensure that you can easily void with the pessary in. Your pelvic physio will also check to make sure the pessary is in the right spot and that there’s adequate clearance around the pessary (ie. that it’s not too big).  

What follow up is required after my pessary fitting?

Assuming your pessary fitting was successful (ie. we found one that works great for you!) and your pessary is in stock, you will leave your fitting with your pessary.  We strongly recommend a follow-up 1-2 weeks after your initial fitting to check your tissue health (make sure your vaginal tissues are tolerating the pessary well), troubleshoot any concerns, and provide any further guidance needed to optimize your experience.  Additional follow up at 1 and 3 months later is also recommended.  Annual vaginal checks are also required, though these can be conducted by your physician.

If you aren’t happy with your pessary and want to try yet a different size or type, we can also book a repeat fitting session.

What are the costs associated with a pessary fitting?

Initial pessary fitting (90min session): $220

Pessary re-fitting – return clients only (60min) $180

Pessary follow up (45min): $110

Pessary follow up (30min): $75

Cost of pessary: $85

If you have benefits that cover physiotherapy, the cost of your pessary fitting and follow up appointments can be claimed in accordance with your physiotherapy coverage.  We offer direct billing for most insurance companies. Alternatively, you can pay upfront and submit on your own.  Many benefit plans also reimburse the cost of the pessary though you need to manually submit that.

Is this service covered by Alberta Healthcare?

Our clinic does NOT receive any government funding for pessary fitting services. If you require this, you can ask your physician to refer you to an AHS-funded pessary clinic in Edmonton, however the waitlists can be very long.  We hope that by providing pessary fitting in our community, more people will be able to access this wonderful, conversative option in a more timely manner to get back to the lives they love.

Further questions??

Email Teresa at teresa@rxphysiotherapy.com