Bladder support pessaries: how do they work?

Bladder support pessaries: extra support from the inside

Updated 2023 (original 2019)

Strengthening your pelvic floor is still the first prize for bladder leakage problems. 

But what if you cannot create enough strength and support for the bladder with your pelvic floor muscles alone?

You may benefit from one of the modern bladder support pessaries that give some reinforcement to the bladder neck and bladder tube.

These are devices that you can buy on the internet and then insert and remove yourself. They are designed to be worn all day but not all the time. These can be a surprisingly inexpensive & eco-friendly option, compared to disposable pads. Ideal if you know when you will leak and need to use the device only for intermittent pre-planned activities.

Available in the UK are, Contrelle, Contiform, Eufemia, and Uresta.  They vary in price chiefly relative to how many times they can be re-used.  Contiform and Efemia are available on prescription.

Would they suit you?

Have you done your pelvic floor exercises, improved your core, modified high impact, and improved your fluid management?

Still not quite resolved your bladder leakage? Then one of the bladder support pessaries may offer an alternative to surgery (NICE Guideline NG123 2019). They have a similar mechanism of action  (mechanical support of the urethra) to the TVT and colposuspension surgical procedures but no side effects or surgical risk.

In my clinical experience, these support pessaries work particularly well in certain situations.  For example

• when the bladder has dropped only a little bit and the uterus is still well supported.
• or, if exercises have created a good layer of muscles but you still need more bladder support to be active.

How do internal bladder support pessaries reduce urinary leakage?

These devices work by providing more support for the bladder neck. 

When you move fast (eg jogging, playing tennis) or there is an increase in abdominal pressure (coughing, sneezing, jumping), the pelvic floor muscle is supposed to support the bladder neck so that there is no leakage.  However, if the muscles are weakened and/or untoned that support can be lost. 

Are you a visual person?   Imagine a running hose pipe, lying on soft grass.  When you lay your foot on the pipe you may slow the flow of water. But you may not be able to stop it completely.  However, if you lay your hosepipe on a firmer surface, like a garden path, when you press down on the hosepipe the water flow stops.

A toned pelvic floor should act like that firm path. But if yours isn’t up to scratch a pessary could do that job instead.

What type of urinary leakage will they help?

Bladder support pessaries are best

• for small leaks associated with movement
• or leaks when the bladder is under pressure from coughing, sneezing, or laughing (stress urinary incontinence).

They create a mechanical uplift to support the bladder neck the way the pelvic floor is supposed to do. 

These would suit women who don’t generally experience day-to-day stress incontinence but know when they are going to leak. For example,

• if you know you will have incontinence if you do a run, or when you go to Zumba
• or if you feel anxious about an event, like going to a wedding, or travelling.

You might only use a product like this once or twice a week. With one of these is you might not need any other protection, or would feel confident with simply a liner or a pair of washable knickers “just in case”.

What these devices can’t do is change symptoms like urgency. 

If your bladder is irritated by caffeine, being too full, or you have an overactive bladder, you won’t see any improvement using one of these.  Pelvic floor exercises DO help these symptoms because the pelvic floor contracting activates neurological messages which calm the bladder down.  Unfortunately, these devices can’t do that. 

If urgency or frequency symptoms are your bothers – then you need to practice “endurance/holding pelvic floor exercises (see more in the Pelvic Floor School) and have also read of the article “How much should you drink in day and when should you have a wee?” for more impact on these problems.

Can I leave it in to wee?  What about during my period?

Yes, they are all designed to be left in when you have a wee or bowel movement.  The pressure of the bladder squeezing is enough to push the urine past the supported area when you need to.

You can still use the Contiform & Efemia pessary when you had a period (as the menstrual fluid can flow past it) but you couldn’t use a tampon at the same time.  The other designs (Contrelle, Efemia & Uresta) act as a block but are not absorbent like a tampon, so shouldn’t be used during your period.

Note: The term pessary can be confusing

Because these devices to reduce bladder leakage sit inside the vagina they are termed a “pessary” but they should not be confused with a traditional pessary used for supporting Pelvic Organ Prolapse (POP). For more information about pessaries for prolapse read here

Field Guide: bladder support pessaries available in the UK

Each company markets its own product and may use more than one distributor so prices can vary.  Here is my personal “quick guide” to what’s out there at the moment, apologies if it has already changed again by the time you read this!  Please do let me know if I have missed something, or if you find a new supplier or product before me! Please do comment to support other readers & share your experiences:

Contrelle Activgard

Contiform

The principle of the Contiform is to create uplift and support for the neck of the bladder.  These are guaranteed to be reusable for up to 30 insertions. So if you

felt you needed support daily rather than ad hoc this is likely a more economical option in the longer term.

The Contiform Pessary looks like a plastic hollow tampon.    The smaller circle supports the bladder tube (the urethra). The larger surface lies against the floor of the vagina, giving support to the bowel wall.  They are made of a firm but flexible non-latex plastic. Each can be reused, with a guarantee of up to 30 times. There is a “slit” that develops with wear to show you when the device needs changing. Use for longer if not worn all day. There is an optional ribbon to help with removal.

You can buy Contiform online or they are available on NHS prescription.  You would need to tell your GP about your symptoms and ask them to prescribe a starter pack for you. 

While you are there ask for a referral to specialist physiotherapy too if you haven’t already got your own pelvic floor coach(!).  Especially if using a Contiform works for you – it suggests that a stronger pelvic floor could do this job naturally for you too!

 

Efemia Bladder Support

The newest member of this ‘family’ of bladder support pessaries. Efemia feels more petite, lighter and softer than the Contiform & Uresta. It is made of transparent flexible medical grade silicone.

It is designed to sit lower in the vagina, tucking just behind the pubic bone. Similar to the space where a TVT procedure is positioned.

Positioning correctly is straight forward. You leave the handle part on the outside of the body, but this could be irritating to the labia or vulva tissues for some women (efemia recommend using water based lubricant if this occurs). The external loop makes it easy to remove. It needs just a rinse between uses. You can leave it in place during menstruation but you could not use a tampon at the same time.

The Efemia website has a good video to show you the position it takes up and how this helps to support the bladder tube (the urethra) as you cough or move.

Like Contiform and Uresta it’s effectiveness is supported by small clinical trials. It is available on NHS prescription in England. You would need to tell  your GP about your symptoms, and ask them to prescribe a starter pack for you. 

While you are there ask for a referral to specialist physiotherapy too. Especially if using an Efemia Bladder Support works for you. That suggests that a stronger pelvic floor could do this job naturally for you too!

Uresta

Uresta, designed and manufactured in Canada, joins this family of internal support devices with the unique selling point that it is fully reuseable for one year.

So if you have had good success with one of the devices above this would be a natural progression to a potentially more environmentally friendly and overall less expensive option.

A clinical trial of 32 women found that of those still using it at 2 weeks (21 women out of the original 32), 76% of them (16) were still using it at their 12 month visit.*

*    Farrell SA, Baydock S, Amir B, et al.  Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women.  Am J  Obst  Gynaecol 2007:196:474e.1-474.e8

There is a helpful video on their website. If you are worried about the high initial cost Uresta offer a full money back guarantee. There is also give good advice about how to find the right size for you.

Beware misleading marketing

Some of the marketing blurbs list “strengthen your pelvic floor” as a benefit of using their pessary device.  This is only true in the loosest meaning.

While they are in place, by artificially re-inforcing the vagina wall,  I suppose you could claim that is “strengthening” the pelvic floor action – but they are in no way making any change to the muscle. 

Only exercise can change the composition and activity of the muscles or surgery the non-muscular elements.  When you take the device out the structural situation remains the same.   

However, these devices definitely offer an alternative to surgery. Or a Buy Some Time option if you need to complete your family or are undecided about a bigger procedure.

Living life to the full

To conclude – I would suggest that these devices are part of your package of things you are doing/using to change the way that bladder leakage limits your lifestyle. Make it your goal to cure your leakage problem rather than simply manage it.

However, if you are not worrying about leaking, you will fee more confident to exercise. This is a Good Thing for your overall health, wellbeing and mood.   

Do contact your local specialist physiotherapist to help support you. She will guide you towards the right products, exercises and sports for your needs

Have you tried one of these internal bladder support pessaries? What did you think? Any tips for other women?

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