A pessary is a removable, medical-grade device, typically made of soft silicone, that is placed inside the vagina to provide structural support to the pelvic organs. Its primary function is to manage symptoms of pelvic organ prolapse, where organs like the bladder, uterus, or rectum descend from their normal position. Pessaries are also commonly used to treat stress urinary incontinence (SUI), which is the involuntary leakage of urine during activities that increase abdominal pressure. For many women dealing with these conditions, maintaining an active lifestyle, especially high-impact activities such as running, is a primary concern.
How Pessaries Support High-Impact Movement
Using a pessary makes it possible to engage in running and other high-impact activities without experiencing symptoms. The device acts as an internal support system, similar to how a sports bra provides external support during exercise. During dynamic activities like running, continuous impact generates significant downward force (intra-abdominal pressure) which pushes on the pelvic organs.
A properly fitted pessary counteracts this pressure by mechanically supporting the vaginal walls and repositioning the pelvic organs. This lift helps keep the bladder, uterus, and rectum in a more anatomically correct position. This support reduces the feeling of pelvic heaviness or bulging that often accompanies prolapse during exercise.
For stress urinary incontinence, the pessary provides support beneath the urethra, often by slightly elevating the bladder neck. This compression helps maintain urethral closure pressure, preventing urine leakage during impact activities like running, coughing, or sneezing. The pessary manages symptoms, allowing the pelvic floor muscles to work more efficiently during strenuous activity. Some individuals wear the pessary only during higher-impact events as situational support.
Choosing the Best Pessary Type for Running
Choosing a pessary for running requires careful consideration of its shape, as different designs offer varying levels of support for dynamic movement. The choice depends on the specific condition being managed, whether it is pelvic organ prolapse, stress urinary incontinence, or both. Higher-support designs are often recommended for athletes engaging in high-impact sports.
The cube pessary is frequently favored for athletic use because it is a space-occupying device that uses suction to remain in place, offering robust support even with reduced vaginal tone. The ring with support, or the dish with urethral support (incontinence dish), is another common choice, as the thickened area provides direct compression to the urethra to prevent leakage during impact. Other space-filling options like the Gellhorn pessary are typically reserved for more advanced prolapse and are less practical for high-impact sports.
The fitting process is a specialized procedure conducted by a healthcare professional, such as a gynecologist, urologist, or pelvic health physical therapist. The practitioner assesses the dimensions of the vagina and the degree of prolapse to determine the most appropriate size and style. Finding the correct fit is paramount for running; the device must be large enough to stay securely in place during rapid movements but not so large that it causes discomfort or pressure. Self-management, including insertion and removal, is also a factor, as some athletes prefer a device they can use only for a run and remove immediately after.
Recognizing Signs of Improper Pessary Fit
While a correctly fitted pessary should be unnoticeable, certain symptoms during or after running indicate the device is not functioning optimally and requires professional adjustment. The most immediate sign of a poor fit is the pessary shifting, feeling like it is slipping down, or outright falling out during exercise. If the pessary is too small, it cannot withstand the increased intra-abdominal pressure generated by running, leading to displacement.
A significant increase in stress urinary incontinence or a new onset of leakage while running suggests that the device is not providing adequate support to the urethra. Similarly, the reappearance of pelvic heaviness, pressure, or a bulging sensation immediately after a run signals that the pessary is failing to maintain the pelvic organs in their correct alignment. Persistent pain, discomfort, or a feeling of rubbing are also strong indicators that the size or shape is incorrect or that the device is irritating the vaginal walls.
Any unusual vaginal discharge (bloody, foul-smelling, or changed color) warrants immediate consultation, as this can indicate vaginal wall irritation or a potential infection. If any of these signs occur, especially if the pessary is newly fitted, the wearer should stop the activity and seek an appointment for a refitting. A successful fit often requires a trial-and-error process to ensure stability during the specific demands of running.