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Physical Therapy
Pessary Use and Physical Therapy
What a Pessary Is and How It Works
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A pessary is a removable medical device inserted into the vagina to support the pelvic organs.
It is most commonly used to manage:
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Pelvic organ prolapse (when the bladder, uterus, or rectum descends from its normal position)
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Stress urinary incontinence (leakage with coughing, lifting, or exercise)
Pessaries come in different shapes and sizes, including:
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Ring pessaries
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Cube pessaries
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Incontinence dish pessaries
When properly fitted, a pessary sits comfortably in the vaginal canal and provides structural support. Many patients are able to wear a pessary during daily activities and exercise, and some types can remain in place during intercourse.
A pessary does not cure prolapse. It is a management tool that reduces symptoms such as:
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Vaginal bulging
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Pelvic pressure or heaviness
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Difficulty emptying the bladder or bowel
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Urinary leakage
For some patients, it serves as a long-term solution. For others, it provides symptom relief while they pursue pelvic floor rehabilitation or consider other treatment options.
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Can You Do Pelvic Floor Therapy While Using a Pessary?
Yes. In many cases, pessary use and pelvic floor physical therapy work well together.
Supporting the pelvic organs with a pessary can reduce discomfort enough to allow patients to engage more comfortably in exercise and rehabilitation.
Pelvic floor strengthening is not contraindicated with pessary use. In fact, improving muscle function may enhance long-term outcomes.​
How Physical Therapy Supports Pessary Use​
Physical therapy plays an important role before, during, and after pessary use.
Before Pessary Fitting
Prior to fitting, I assess:
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Pelvic floor muscle strength
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Muscle tone (overactive vs. underactive)
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Coordination
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Trigger points or myofascial restrictions
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Core and hip mechanics
This evaluation helps determine whether a pessary is appropriate and identifies contributing factors beyond the prolapse itself.
After Pessary Placement
Once a pessary is in place, treatment focuses on restoring pelvic floor function.
This may include:
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Strengthening pelvic floor muscles
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Improving coordination between the pelvic floor and deep core
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Reducing excessive intra-abdominal pressure
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Addressing movement patterns that strain pelvic structures
When appropriate, I use manual therapy, myofascial mobilization, and dry needling to address muscular restrictions in the hips, adductors, gluteals, and abdominal wall.
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If a Pessary Feels Uncomfortable
Discomfort is not always a fitting issue.
Sometimes contributing factors include:
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Pelvic floor muscle tension
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Tissue sensitivity
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Positional habits
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Myofascial restrictions
These often respond to relaxation training, manual therapy, and gradual desensitization.
Education is also part of the process. I help patients understand pessary care, what to expect as they adjust, and how pelvic floor rehabilitation fits into their broader treatment plan.
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When to Consider a Pessary for Pelvic Organ Prolapse
Patients consider pessary use for several reasons:
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Sensation of vaginal bulging
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Pelvic pressure or heaviness that worsens with standing
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Tissue protruding at the vaginal opening
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Difficulty emptying the bladder
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Stress urinary incontinence
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Desire to avoid or delay surgery
A pessary is not appropriate for every patient, and it is not the only treatment option. However, for many individuals with pelvic organ prolapse, it provides meaningful symptom relief and allows them to stay active and comfortable.
When combined with pelvic floor physical therapy, a pessary can be part of a comprehensive, conservative management approach.
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When to Seek an Evaluation for a Pessary​
If you are experiencing symptoms of prolapse or urinary leakage and are unsure about your options, an evaluation can help clarify:
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The severity of the prolapse
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Whether a pessary is appropriate
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Whether pelvic floor rehabilitation alone may be sufficient
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Or whether a combined approach is ideal
An assessment provides clarity and helps you make informed decisions about your care.
Every visit is one-on-one and focused on identifying the underlying cause of your symptoms so treatment is specific to your body and goals. Call 708-512-5124 today to schedule your appointment.
Pessary Use FAQ​
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Can pelvic floor physical therapy help if I already have a pessary?
Yes. Pelvic floor physical therapy works alongside a pessary to improve muscle function, coordination, and support. Therapy can address tension, overactivity, or weakness that may affect comfort or symptom relief. By combining therapy with pessary use, many people notice improved comfort during daily activities and exercise. Physical therapy also helps you understand how to move, breathe, and manage pressure so your symptoms are easier to control.
Do pessaries weaken the pelvic floor muscles?
No. A properly fitted pessary does not weaken your pelvic floor. In fact, it often allows your muscles to work more effectively while providing support. Physical therapy can be used together with a pessary to strengthen, relax, or retrain the pelvic floor as needed. This approach helps maximize your natural support and can reduce dependence on the device over time if desired.
Will I feel the pessary during daily activities?
Most people do not feel a properly fitted pessary during normal activities like walking, sitting, or exercising. Some initial awareness is normal as your body adjusts, but discomfort usually resolves once the fit is correct. If you experience pressure, rubbing, or pain, your provider or physical therapist can help adjust the size or position. Pelvic floor therapy can also improve muscle coordination and relaxation, making the pessary feel more comfortable and supportive.
Can I exercise or be active with a pessary?
Yes. One of the main benefits of a pessary is that it allows you to stay active while managing pelvic organ prolapse or leakage. Proper fit and placement help you move, lift, or exercise comfortably. Pelvic floor physical therapy can further improve function by teaching how to coordinate breathing, posture, and muscle activation during activity. Together, therapy and a pessary can make exercise safer and more comfortable while reducing symptom flare-ups.
Do I need pelvic floor therapy if my pessary is helping?
Even if a pessary reduces symptoms, physical therapy can address the underlying causes of prolapse or leakage. Therapy helps improve pelvic floor coordination, strength, and pressure management so your symptoms are easier to control and may reduce reliance on the device over time. Working with a physical therapist ensures your muscles are supporting your pelvis effectively and your symptoms are less likely to return. Combining therapy with pessary use provides the best chance for long-term comfort and function.
Is pessary use permanent?
Not necessarily. Some people use a pessary long-term, while others use it temporarily during recovery, postpartum, or while improving pelvic floor function. Usage depends on your goals, comfort, and symptom management. Pelvic floor physical therapy can help improve muscle function and support so you can potentially reduce or stop using a pessary in the future. Therapy also ensures your muscles stay strong and coordinated, maximizing the benefits of the device while keeping you active and comfortable.