How Do I Know If I Need a Pessary or Another Treatment?

A Guide from the Women’s Health Physical Therapists at PhysioFit of North Carolina

Pelvic floor issues, including pelvic organ prolapse (POP) and stress urinary incontinence, can significantly impact a woman’s quality of life. If you’re experiencing pressure, heaviness, bladder leakage, or discomfort, you may be wondering if a pessary is the right solution for you—or if other treatments might be more beneficial.

At PhysioFit of North Carolina, our women’s health physical therapists specialize in pelvic health rehabilitation, including pessary fittings and non-surgical treatment options. In this blog, we’ll help you understand:

✔ What a pessary is
✔ Who might benefit from one
✔ What other treatment options exist

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What Is a Pessary?

A pessary is a small, medical-grade silicone device inserted into the vagina to help support the bladder, uterus, or rectum. It acts as a non-surgical support system for conditions like pelvic organ prolapse (POP) and stress urinary incontinence (SUI).

Pessaries come in different shapes and sizes (ring, cube, donut, Gellhorn, etc.), and a proper fitting by a trained provider—like a women’s health physical therapist—is essential for comfort and effectiveness.

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Signs You May Benefit from a Pessary

A pessary may be a good option if you are experiencing:

✅ Pelvic pressure or heaviness – A feeling of “something falling out”
✅ Bladder leakage with activity – Coughing, sneezing, or exercising causes urine leakage
✅ Difficulty emptying your bladder or bowels – Due to organ prolapse
✅ Discomfort during prolonged standing or walking – Symptoms worsen as the day progresses
✅ Desire to avoid or delay surgery – A pessary provides non-surgical support

If these symptoms sound familiar, a pessary fitting might be a great first step in managing your condition.

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Who Might Need an Alternative Treatment?

While a pessary can be very effective, it isn’t the best solution for everyone. Some women may benefit more from pelvic floor physical therapy, lifestyle changes, or, in some cases, surgical consultation.

You may need alternative or additional treatments if:

❌ You experience discomfort or irritation when wearing a pessary
❌ You have recurring infections or difficulty keeping the pessary in place
❌ You are unable to insert/remove it independently and prefer a different approach
❌ Your prolapse or incontinence is severe enough to require surgical correction

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Alternative Treatment Options for Pelvic Floor Support

At PhysioFit of North Carolina, we offer a range of evidence-based treatments to address prolapse and incontinence, whether or not you choose to use a pessary.

🔹 Pelvic Floor Physical Therapy

✅ Strengthens weak pelvic floor muscles to provide better support
✅ Teaches proper muscle coordination for bladder control and stability
✅ Focuses on breathing, core stability, and posture to reduce pressure on the pelvic floor

🔹 Lifestyle & Habit Modifications

✅ Bladder training techniques to reduce urinary urgency/frequency
✅ Activity modifications to prevent symptom worsening
✅ Nutritional guidance to avoid constipation, which can worsen prolapse

🔹 Surgical Consultation (If Needed)

If conservative treatments aren’t enough, we may refer you to a urogynecologist or pelvic health specialist for further evaluation. Surgery is not the first option, but in advanced cases, it can be a long-term solution.

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How Can We Help?

At PhysioFit of North Carolina, we specialize in:
✔ Pessary fittings for non-surgical symptom relief
✔ Pelvic floor therapy to strengthen and restore function
✔ Comprehensive assessments to find the best solution for you

If you’re unsure whether a pessary, physical therapy, or another treatment is right for you, we’re here to help!