Pelvic & vaginal health

Pessaries for Stress Leaks: A Non-Surgical Option

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A pessary is a soft, removable silicone device placed in the vagina to support the bladder neck and reduce stress leaks without surgery. According to ACOG, it is an effective nonsurgical option [1]. Continence designs add resistance during coughing or exercise, a clinician fits the size, and many people insert and clean it themselves at home.

Last updated: July 2026

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What is a pessary for bladder leaks?

A pessary is a flexible silicone device inserted into the vagina to give internal support, and continence versions are shaped to lift the bladder neck. That support firms up the angle of the urethra, so less urine escapes during a cough, a laugh, or a jump. Pessaries have been used in gynecology for well over 100 years, and continence designs apply the same idea to stress leaks.

There is an important distinction between types. Some pessaries treat pelvic organ prolapse, some target stress incontinence, and a few do both. According to ACOG, both prolapse and stress incontinence can be managed with a well-fitted pessary as a nonsurgical option 2. Choosing the right shape is part of the fitting visit.

How does a pessary reduce stress leakage?

Stress leaks happen when a sudden rise in abdominal pressure overwhelms a urethra that no longer seals tightly. A continence pessary presses gently against the vaginal wall behind the urethra, restoring support at exactly that point. The added backing raises the pressure needed to force urine out, so coughing or lifting causes fewer leaks.

Many designs include a small knob or ridge positioned under the bladder neck for extra effect. Some women wear a pessary only during pelvic floor physical therapy sessions or high-impact workouts, while others use one daily. A Cochrane review supports pessaries and pelvic floor training as effective conservative management 1.

Who might consider a pessary?

A pessary suits people who want to avoid or delay surgery, and it appeals to those whose leaks are mainly triggered by exercise or lifting. It can also help during pregnancy, while waiting for a procedure, or when surgery is not a safe choice. Because it is removable and reversible, a 2 to 4 week trial carries little downside.

It pairs naturally with other conservative steps rather than replacing them. Combining a pessary with pelvic floor muscle exercises often works better than either alone, and broader treatment options for urinary incontinence in women remain available if it falls short. According to the Menopause Society, thinner postmenopausal tissue sometimes needs vaginal estrogen alongside a pessary for comfortable long-term use 3.

What is it like to use and care for one?

A clinician fits the pessary in the office, trying sizes until one feels secure and unnoticed, which can take more than 1 visit. Once fitted, many people learn to remove, clean, and reinsert it themselves, often nightly or every 2 to 3 days depending on the design. Warm water and mild soap are usually all that cleaning requires.

Follow-up checks matter, especially early on and after menopause, when vaginal dryness after menopause can affect comfort and fit. Many clinicians schedule checks every 3 to 6 months. If a pessary feels painful, falls out, or causes discharge or spotting, a clinician can refit or switch designs. According to ACOG, regular follow-up keeps pessary use safe and comfortable over the long term 2.

When bladder leaks need a gynecologist

Fitting a pessary is a clinician's job, so bladder leaks that interfere with daily life are worth raising with a gynecologist or trained primary care clinician. Pessaries serve women across life stages, from exercise or postpartum leaks in younger women to the tissue changes that follow menopause, though the fit and care differ by stage 1. A fitting visit also clarifies whether leaks are stress, urge, or mixed.

Pain, unusual bleeding, foul discharge, or a device that will not stay in place is a reason to seek clinician review rather than persisting alone. Gale can help you prepare for a fitting conversation so you know what to ask.

Common questions

It is a soft, removable silicone device placed in the vagina to support the bladder neck. Continence designs firm up the angle of the urethra so less urine escapes during coughing, lifting, or exercise. It offers a nonsurgical middle path between relying on pads and having surgery.

A well-fitted pessary should feel secure and largely unnoticed. Fitting may take more than one visit to find the right size, and early discomfort usually means the size or shape needs adjusting. Pain, a device that slips out, or new discharge is a reason to check back with your clinician.

Often, yes. After a clinician fits it, many people learn to remove, clean, and reinsert the device themselves, typically with warm water and mild soap. How often depends on the design, ranging from nightly removal to every few days, with periodic clinician follow-up.

For many women it provides meaningful relief without surgery, especially for stress leaks triggered by exercise. It is reversible and low-risk, so it is often tried first. If it does not control leaks well enough, other treatments, including surgery, remain available.

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When pessary use needs clinician review

  • —Pelvic pain or pressure with a pessary in place is a reason to seek clinician review
  • —Unusual vaginal bleeding or spotting is a reason to seek clinician evaluation
  • —Foul-smelling discharge is a reason to seek clinician review
  • —A pessary that repeatedly falls out or will not stay is a reason to seek clinician review
  • —Difficulty passing urine or stool with a pessary in place is a reason to seek prompt clinician review

This article is general health education, not medical advice. A pessary must be fitted and monitored by a gynecologist or trained clinician, who can select the design and check for complications.

References

  1. 1.Hagen S, Stark D (2011). Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD003882.pub4 ✓Cochrane review that pessaries and pelvic floor muscle training are effective conservative options for pelvic floor disorders across life stages
  2. 2.American College of Obstetricians and Gynecologists (2019). Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000003519 ✓ACOG guidance that a well-fitted vaginal pessary is an effective nonsurgical option for prolapse and stress incontinence, requiring fitting and regular follow-up
  3. 3.The North American Menopause Society (Menopause Society) (2020). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. doi:10.1097/GME.0000000000001609 ✓Menopause Society statement that thinner postmenopausal urogenital tissue may require vaginal estrogen for comfortable long-term pessary use

3 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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