Pessaries need to be rebranded.  They should be called something like “dry run enhancer” or “performance improver” or “underwear protector”.  A name to show off their positive impact on dryness during exercise.  Furthermore, we should also start thinking about them like an athletic cup- just part of the gear.  Something you throw on before you head out.  You always change into your sports bra, don’t you?  Throw on your favorite running shoes or cross trainers? And pessaries for bladder leakage can stop leaking with exercise.

What is a pessary for bladder leakage?

A pessary is a device that fits in the vagina (yep) and supports the urethra (the tube that leads from the bladder to the outside).  It puts a little pressure on the urethra and makes it more difficult for the urine to leak out.  But you should be able to empty your bladder while wearing one.  Pessaries for bladder leakage come in different shapes and sizes.  Some require a doctor’s visit for a fitting and are reusable.  Others are available over the counter but are single-use only.  Each different type of pessary can be worn for a different length of time.  Be sure you know how long you can wear your pessary.

When you have a pessary, you can decide when to wear it and when leave it out- it puts you in charge.  If you ever read running blogs, you’ll see comments about women leaking less when running with a tampon or a menstrual cup.  Without realizing it, these women are using the tampon/menstrual cup as a pessary.  Pessaries work well to improve bladder leakage with exericse, but they only work while you are wearing one.

What does the data show about pessaries for bladder leakage?

So what does the data show?  There are many small studies that look at women trying a new incontinence pessary (without a control group).  These studies show that most women are significantly better with a pessary and that most are still using it a year later.^1,2  There is one randomized controlled trial that looked at women with stress urinary incontinence and mixed urinary incontinence.³  These women did one of three things for their leaking:

• • Pessary
  •  Behavioral therapy (mostly pelvic floor exercises and skills and strategies on how to prevent leaking)
  •  Both a pessary and behavioral therapy

In this study, 40% of the pessary group were much better and about 50% of the other two groups.  After a year, the interventions continued to work and about half of the participants were satisfied with the treatment.³  These numbers likely underestimate how well a pessary works.  In this study, half of the women had mixed urinary incontinence and a pessary only treats stress urinary incontinence.  So half of the women had the type of leakage that a pessary would NOT treat.  The study was also looking at a pretty large age range and pessaries may work better in younger women.

Why try a pessary for bladder leakage?

A pessary is worth a try.  They’re not expensive.  There aren’t really side effects.  You can stop using it when you want.  Women decide pretty quickly if this is a good option for them.  And it doesn’t have to be your final solution- you can use a pessary to fill in the gap while you’re waiting for another treatment to work.  Or until you have space and capacity to do something else. So maybe you are trying to lose weight and improve your pelvic floor strength- why not use a pessary until you are where you want be?  Or if you have a new baby, are leaking and waiting for your pelvic floor to wake up?  Or maybe even waiting to schedule surgery.  Think about it.  You might just love it.

What pessaries for bladder leakage are out there?

Here is a list of some of the available pessaries.  There are frequently more coming to market so this list won’t be complete for long.  Clicking on most of the images will bring you to the respective website.

Incontinence pessary

This is a traditional incontinence pessary. You have to see a provider to get one and you will have to be fitted for the correct size.  They are made out of silicon, are reusable, and can be worn for long periods of time.  They generally last for several years.  Most Ob-Gyn’s, some Primary Care Physicians, and some Urologists will have them in the office.

Impressa

This is the Impressa (made by Kimberly Clark), the first over the counter incontinence pessary for bladder leakage available in the US.  It has been on the market since 2015 and comes in 3 sizes. You can only wear it once and are not supposed to wear it for longer than 12 hours in a 24 hour period.  It is easiest to get on-line. Sometimes the material is a little uncomfortable and lubricating the tip of the applicator helps.

Revive

This is Revive, an over the counter pessary that was new in 2020.  It comes in one size.  It is only to be worn for 12 hours in a 24 hour period.  Each pessary can be worn for 31 days. 

Uresta

Uresta has been available in Canada for several years and is now available in the US with a prescription.  There are different sizes.  It can be worn for long periods and each one lasts a year.

International pessaries

There are other types of incontinence pesseries that are available in other countries, frequently England, New Zealand and Australia.  Each country has different regulatory laws and it takes longer to get things approved in the US.  These “international” pessaries may be available here soon!

1. Ziv E et al AJOG 2008;198(5):e1-7.
2. Farrell SA et al. AJOG 2007;196(5):474e1-8.
3. Richter HE et al. Obstet Gynecol 2010;115 (3):609-617.