A pessary is a removable medical device, typically made of soft silicone, inserted into the vagina to provide internal support for the pelvic organs. It is most often used to manage symptoms of Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). The device acts as a non-surgical option for women experiencing a descent of the uterus, bladder, or rectum into the vaginal canal, or those who leak urine with physical exertion. Since an active lifestyle is encouraged for overall health, exercising while wearing a pessary is common, and for most users, physical activity remains compatible with the device.
How Pessaries Provide Support During Movement
Physical activities inherently cause a transient increase in Intra-Abdominal Pressure (IAP), the downward force exerted on the pelvic floor. Activities like running, jumping, or lifting elevate this pressure, and without adequate support, this force can worsen the descent of prolapsed organs or cause involuntary urine leakage. The pessary is specifically designed to counteract this downward force by acting as a stable, internal mechanical barrier. It holds the pelvic organs, such as the bladder and uterus, in a more anatomically correct position, effectively serving as a supportive scaffold.
For those with stress urinary incontinence, certain pessary types, such as the incontinence ring, feature a thicker portion positioned beneath the urethra. This placement provides a firm point of resistance, offering compression that prevents urine from escaping when IAP spikes during exercise. The support offered by the device significantly reduces the strain on the pelvic floor muscles. Clinicians encourage wearing the pessary during physical activity because it mitigates this pressure, allowing the user to remain active without experiencing symptoms.
Low-Impact Activities Safe for Pessary Wearers
Low-impact activities are generally considered safe and highly recommended for pessary users because they minimize the intense pressure fluctuations that stress the pelvic floor. Walking is an excellent foundational activity, as the rhythmic motion and low ground reaction force are unlikely to cause displacement or significant increases in IAP. Similarly, activities performed in water, such as swimming or water aerobics, benefit from the buoyancy that naturally reduces the body’s weight and the impact on the pelvic structures.
Seated exercises, like stationary cycling, remove the impact component entirely and allow for effective cardiovascular conditioning while the body is well-supported. Gentle strength training using light resistance is also appropriate, provided the user focuses on controlled movements and avoids breath-holding, which dramatically increases IAP. The key to maintaining safety during any low-impact exercise is coordinating movement with breath: always exhale during the point of physical exertion.
Yoga and Pilates can also be beneficial, but users should stick to gentle, modified forms that avoid intense abdominal flexion or inverted poses. Pilates emphasizes deep, coordinated breathing and core engagement that supports the pelvic floor rather than straining it.
Modifying High-Impact Exercises
Activities that involve repeated high-impact landing, such as running, jumping, and plyometrics, generate substantial IAP and carry a higher risk for pessary displacement or symptom recurrence. These activities require careful modification to reduce the intensity of the downward force. For runners, transitioning to lower-impact alternatives like an elliptical trainer or a brisk power walk can provide similar cardiovascular benefits without the jarring impact of ground contact.
Heavy weightlifting, especially with exercises like squats or deadlifts, should be approached with a reduction in the weight load to ensure proper form and pressure management are maintained. A common modification is to focus on lifting a weight that allows the user to easily exhale as they lift, avoiding the Valsalva maneuver (breath-holding and bearing down).
For core work, traditional exercises like crunches or sit-ups can be replaced with pelvic-floor-safe alternatives, such as modified planks or exercises done in a supine position with the feet supported. Users can also employ the “knack,” a pre-emptive pelvic floor muscle contraction performed immediately before and during a cough, jump, or lift.
Monitoring and Maintenance During Increased Activity
An active lifestyle requires consistent attention to the pessary to ensure it remains effective and does not cause irritation. Users should always check the device’s position before engaging in strenuous activity, confirming it feels correctly seated and comfortable. After the activity, especially following intense exercise or swimming, it is important to check the device again and perform any necessary cleaning.
Signs of potential displacement or fit issues include an increase in pelvic pressure or heaviness, a return of urinary leakage that the pessary previously controlled, or feeling the device shift or rub uncomfortably. If the device feels like it is falling out, or if the user is unable to easily remove and reinsert a self-managing pessary, they should contact their healthcare provider. Regular hygienic maintenance is also important, which for self-managing users involves removing, cleaning, and reinserting the pessary according to the clinician’s schedule.
Contact a healthcare professional immediately if any concerning symptoms arise, such as persistent vaginal pain, foul-smelling discharge, or unexplained vaginal bleeding. Consistent professional follow-up is necessary to check the fit and inspect the vaginal wall for any signs of irritation or erosion. These checks are typically scheduled soon after the initial fitting and then every three to six months.