Pessary Devices and Bladder Support Products for Women

Pessary devices are inserted into the vagina to treat stress incontinence and pelvic organ prolapse (POP). They come in many shapes and sizes and are typically made from medical-grade silicone. A pessary ring offers the best bladder support and is often used as a first-line treatment, while a donut pessary is usually reserved for more advanced POP.

Before discussing surgery, doctors will frequently try a series of pessary devices in different shapes and sizes. Even though not a cure, a vaginal pessary can delay or even avoid bladder surgery altogether and it is a low-cost, low-risk option for all prolapse stages. The downside is that this type of bladder support for women can cause discomfort, pain, and difficulty with sexual intercourse. Pessary devices also need multiple fittings, periodic replacements, and regular doctor appointments. Bladder surgery may be a better option if you need incontinence care and pessaries no longer help with your symptoms. The main cons of surgery are long recovery time, high cost, and risk of surgical complications. It is usually recommended in late-stage bladder prolapse.

Uncomfortable as it may be, pessary devices are fitted through trial and error and a gynecologist is the most qualified person to decide what size vaginal pessary you need. Size is not the only consideration though. Even medical professionals won't be able to tell right away what type of bladder support device suits you best, so you may need to try different sizes AND styles before finding your match. Similar to fitting a diaphragm, you should settle for the largest size of pessary ring that fits comfortably. Rings range from 2 to 7 and the average sizes are 4 and 5.

After deciding on the right fit, pessary devices will first be inserted by your doctor. Depending on the shape of bladder support that suits you best, they will train you on properly inserting and cleaning the vaginal pessary. You will return to the clinic after a week to check the fit and whether your vagina shows any signs of irritation. Note that pessary rings are the easiest to install as they can be folded in half for insertion. Gellhorn pessaries are shaped like a mushroom and are more difficult to remove and install on your own, as are donut pessaries.

Depending on the type of vaginal pessary that you are fitted with, it may need nightly removal or you may leave it in for months at a time. A pessary ring can be either removed or left in for sexual intercourse, whereas cube pessaries have to be removed every night. To prevent infections, an acidifier or estrogen must be applied 2-3 times a week and, if unable to care for the bladder support device on your own, doctors can remove, wash and reinsert it every 3-6 months.

Some types of bladder support for women are available over the counter but pessary devices are usually ordered by your gynecologist once they determine the right size and shape for you. You can also try other over-the-counter incontinence products for women, like reusable incontinence panties and daily protective underwear.

There are almost 20 types of pessary devices out there, but the most common ones for bladder prolapse are rings with support, Gellhorn, Marland, Gehrung (U-shaped), cube, and donut pessaries. The main issue with Gellhorn and donut pessary devices is that they are difficult to remove, while the cube pessaries are uncomfortable and have been associated with vaginal erosions and foul-smelling discharges.