Bladder support pessaries: extra support from the inside

updated 2023 (original 2019)

Strengthening your pelvic floor is still 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 at the moment are , Contrelle, Contiform, Efemia 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 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 in you might not need any other protection, or would feel confident with simply a liner or a pair washable knickers “just in case”.

They can’t help with urgency or irritable bladder

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 bother – 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 could still use the Contiform or Efemia pessary when you had a period (as the menstrual fluid can flow through it) but you couldn’t use a tampon at the same time.  The other designs (Contam, Uresta) act as a block but are not absorbant 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  traditonal pessary used for supporting Pelvic Organ Prolapse (POP). For more information about pessaries for prolapse read here

Field Guide: bladder support pessaries to reduce stress urinary incontinence

Each company markets their 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 out, or you find a new supplier or product before me! Please do comment to support other readers & share your experiences:

Contrelle Activgard

Contiform

Also available on NHS prescription from your GP [starter pack: NHS order code   SKU184 , PIP code 375-5808 ]

The principle of the Contiform is to create uplift and support for the neck of the bladder.  These are guaranteed to be re-usable 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 the guarantee 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 him 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 him 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 mums?

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There has been a recent explosion in “fem-tech” options, particularly pelvic floor biofeedback devices. On the one hand this is empowering women to improve their exercising in the privacy of their own homes, on the other hand resulting in a more than a little confusion about what they do.  With most devices over £100 it is important to spend your money wisely.

Pelvic floor Biofeedback devices

Generally, we advise that if you can already contract your pelvic floor muscles then you don’t need to do passive pelvic floor muscle stimulation. Your muscles will develop quicker by doing ‘active’ exercises where the brain initiates the activity rather than a machine. Check out the videos on our Pelvic Floor School.

However, if you WANT to work with a gadget to do active exercises, a biofeedback device can enhance your practice. Particularly, if you need to work on your brain skills (co-ordination, multi-tasking, downtraining) as much as your isolated muscle strength & endurance (which they can be helpful for too).

How to they work?

• The action of your muscles contracting is relayed to a machine which “shows” you what you are doing.  There are several different ways this can be done.
  • Some machines pick up the electrical signal from your muscles while some respond to pressure.  
  • Some give you a visual picture of what you are doing,
  • others beep or vibrate in response to your contraction.
• Biofeedback devices are great to correctly identify your pelvic floor muscles in different positions. They also ensure you are contracting correctly and also help you focus on relaxing fully between contractions
• These gadgests let you see how well your muscles contract and relax.
• They give targets to aim for to improve strength, endurance and co-ordination.
• Practice more complicated tasks. Skills you need for real life or your sport.
• Make exercising a bit more fun (!) and interesting. This will help you to keep up long-term practice (rather like a piece of gym-kit for your pelvic floor!)

Examples of pelvic floor biofeedback devices:

To be professional, I do not recommend a single specific product or supplier. But I have aimed to narrow down the list of options for  you.  Please do read customer reviews to help you make your decision. Specialist physiotherapists, like myself, have units in clinic for you to try before you buy.

Electrical biofeedback devices: with connecting wires

Peritone EMG biofeedback unit and Simplex EMG biofeedback unit are  the ones we have used in our clinic for many years (same device in different packaging).  Many physiotherapy departments have these for you to use at your visit and/or to borrow. Just like French women train in their postnatal rehabiliation sessions.

They are effectively two parts.  You place a small internal electrode (called a Periform, which is single person use,  into the vagina. Then put your clothes back on!. Then link your internal device by a cable to the handheld Pelvitone or Simplex unit (we can loan one of these to you).  

When you contract your pelvic floor muscles their electrical activity registers on the screen. This makes the  lights change from orange to green and gives an audible beep.  

You can practice your quick maximum power squeezes seeing how high you can make the lights go. Also, practice keeping the lights green while you cough or try moving your arms or legs. There is also a work/rest function which ‘counts’ the endurance holds for you and tells you your average squeeze score at the end.

These devices are widely available from lots of online sellers +/- £160 (including the Periform).

Pelvic floor training devices: which connect via bluetooth to a phone app

Elvie Trainer

It is a discreet, attractive, wireless bluetooth pebble-shaped device. This goes inside the vagina. Use an app to turn your phone into the biofeedback monitor/exercise tracker.  No cables between you and the phone but you can’t put knickers back on or the bluetooth can’t connect. It is beautifully packaged and well designed by women. It can be used in the second trimester of pregnancy but is not recommended for the 1st and 3rd trimesters.

Elvie is officially available “on prescription” but sadly, I don’t know anyone whose managed to get one this way.

Pericoach System

Pelvifly/K-Goal

The largest of the internal probes, which will suit those who find more petite devices fall out too easily. It responds to the pressure of your pelvic floor squeezes. This is particularly useful for those who need to learn to relax the pelvic floor (called downtraining). Pelvifly offers the greatest variety of challenges with innovative vibrant visuals – including butterflies visiting flowers, rockets flying through tunnels, basketballs into hoops and an engaging octopus!

The BASIC plan (no further cost after purchase) sends you a muscle test once a month and daily challenges. With a SMART subscription (£24/month) you will have more programs to follow to suit your chosen goals. Pelvifly are rapidly expanding their telehealth services. With a CARE package (£96/month) you will be connected, virtually, to a Pelvicoach (a specialist physiotherapist) who can interact remotely to set up bespoke assessment and training programmes, support your progress, exchange messages and save and print your progress reports.

Pressure Biofeedback devices

Epi-No (like the Kegel8 Trainer) is less sensitive than the electrical biofeedback or bluetooth devices. However, the advantage of the Epi-No is that it is  certified for use through your whole pregnancy. It can also be used in the latter part of pregnancy (after 37 weeks) to help to stretch the vaginal opening. A recent study * did not show evidence of a protective effect of the Epi-No device on birth trauma, however, anecdotally many women feel it has helped with their confidence to relax the vaginal opening in preparation for birth.

*Kamisan Atan I, et al. BJOG 2016  Does the Epi_No birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial.

Other trainers

This device could also be useful as a ‘bridge’ back to penetrative sex, if you don’t want to use a traditional vibrator. You could practice inserting the trainer at your own pace. You might find the vibration element helpful to re-sensitise your tissues.   They are available directly from www.vibrancepelvictrainer.co.uk  £140.83 with VAT exemption.

This links to a digitally annotated instructional video for Vibrance PFT on youtube:https://www.youtube.com/watch?v=n8IoqefRzTU

Note about VAT exemption

If you have had a problem for more than 3 months, you can declare yourself as having a ‘chronic medical condition’ and do not have to pay VAT. There will be a form to complete. This does not apply to the Elvie which is registered as an exercise tracker not a medical device. Not all the online suppliers can offer this service.

Combined Stim & Biofeedback Machines

You can buy combined units which do both functions. However, these are surprisingly expensive (and a bit fiddly). If you feel you need both systems I usually suggest you buy two separate simpler units and switch between them.

Lubricating gel

You will need a water-based lubricating gel to help the insertion of the devices. It is essential to help the electrical devices to operate correctly. A simple, in-expensive, chemist-own or basic brand name is theoretically all you need. If you have concerns about ingredients you may prefer an organic version.   Do read my posts about the difference between water-based and oil-based lubricating products.

.

Not sure what YOU need?

Get clarity first

If you are not too sure how good your muscles are then before you spend ANY money on a gadget or device I would highly recommend an hour spent with a specialist physiotherapist! Your appointment will be £70-90 outside London.

Our role at physiotherapy is to do an internal assessment of your pelvic floor muscles. We will check how well they are working and teach you how to get the best from them – you may not need any gadgets at all! And if you do we can help you make the best choice for your needs.

Try before you buy

Many physio clinics can loan you both muscle stimulation and biofeedback units to try out at home. To see how well they work for you before you consider buying your own. (NB you still have your own internal probe – no sharing of those!).

It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.

Physios can also teach you active exercises , which require no equipment at all! We usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.

Please don’t hesitate to be in touch if you have further questions. Readers would love to know your experiences if you would be happy to share?

Savage, A.M (2021). Handheld biofeedback devices to enhance pelvic floor muscle training. Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 128, 54-57

Pelvic floor Muscle Stimulation Units

These units are designed to be used at home to artificially stimulate the pelvic floor muscles to work. Electrical impulses are sent from the machine directly to the pelvic floor to mimic the messages that your brain is supposed to send.

These units are ideal for people who really don’t know where their muscles are. Or what they are supposed to do! They are also good for very weak muscles that can only contract a few times before they fatigue. Or muscles that can only muster a very tiny amount of strength.

• the sensations (a sort of tingly feeling) created by the electrical impulses help your brain to correctly identify the location of your pelvic floor muscles.
• the machine will stimulate the muscles to work (contract). It is possible to change the settings to favour different parts of the muscle.
• you can practice joining in with the machine to learn how to contract your muscles without help
• the machine can help you to ‘hold’ a muscle contraction while you concentrate on learning to breathe and/or move at the same time
• we usually recommend that you wait until 3 months postnatally before using a stimulation machine.

Examples of stimulation units:

To be professional, I do not recommend a single specific product or supplier. But I have aimed to narrow down the list of options for  you.  Please do read customer reviews to help you make your decision.  Many specialist physiotherapists, like myself , have units in clinic for you to try out before you buy.

Traditionally the stimulation is delivered by a battery-operated handheld unit with wires to a internal electrode. The price points vary depending on the number of programmes available & the style of the electrode supplied. A new design on the market is Pelviva, which are wireless foam single-use electrodes.

How to use a stimulation machine: video series

I have created a series of videos to show how a machine works, what the cables and probes look like and explain in a not-too-tech way how to use them to help problems with bladder leakage, prolapse or recovery after a baby.

These videos will help you understand your condition, as well as how the machines work. Then, you will be able to decide whether a machine would benefit you and which programmes you would choose.

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You will see that these videos were created as a project for Kegel8. However, you will find most of the information applies to stimulation machines in general.

Note about VAT exemption

If you have had a problem for more than 3 months you can declare yourself as having a ‘chronic medical condition’ and do not have to pay VAT. There will be a form to complete. This does not apply to the Elvie which is registered as an exercise tracker not a medical device. Not all the online suppliers can offer this service.

Combined Stim & Biofeedback Machines

You can also buy combined units which do both functions. However, these are surprisingly expensive (and a bit fiddly) so if you feel you need both systems I usually suggest you buy two separate simpler units and switch between them.

Lubricating gel

You will need a water-based lubricating gel to help the insertion of the devices. It is also essential to help the electrical devices to operate correctly. A simple, in-expensive, chemist-own or basic brand name is theoretically all you need. However, if you have concerns about ingredients you may prefer an organic version.   Do read my posts about the difference between water-based and oil-based lubricating products.

.

Not sure what YOU need?

Get clarity first

If you are not too sure how good your muscles are then before you spend ANY money on a gadget or device I would highly recommend an hour spent with a specialist physiotherapist! Your appointment will be £70-90 outside London.

Our role at physiotherapy is to do an internal assessment of your pelvic floor muscles. We will check how well they are working and teach you how to get the best from them – you may not need any gadgets at all! And if you do we can help you make the best choice for your needs.

Savage, A.M (2019). Neuromuscular electrical stimulation devices. Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 125, 16-25

Try before you buy

We can loan you both muscle stimulation and biofeedback units to try out at home. To see how well they work for you before you consider buying your own. It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.

We can also teach you exercises , which require no equipment at all! We usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.

Please don’t hesitate to be in touch if you have further questions. Readers would love to know your experiences if you would be happy to share?

Savage, A.M (2019). Neuromuscular electrical stimulation devices. Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 125, 16-25

Savage, A.M (2018). Continence products and medication devices: issues that pelvic health physiotherapists need to consider. Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 122, 30-40