Bladder Control Inserts and Continence Pessaries: Do They Stop Stress Leaks?

If you leak during a walk, a tennis match or a coughing fit, you may have seen bladder-support inserts in the drugstore next to the pads. They sit in the vagina and support the urethra so it stays closed under pressure. A clinician can also fit a reusable continence pessary that does the same job. Here is how they compare.

Two types of device

	Drugstore insert	Continence pessary
How you get it	Over the counter, self-fit with a sizing kit	Fitted by a clinician, sometimes trying several sizes1
Use	Inserted for the day or for activities	Worn for longer; cleaned and reinserted at least every 3 months2
Cost	Disposable, so ongoing costs add up2	Reusable device plus fitting visits
Sex	Removed	Some types need removal2

Newer reusable silicone devices that you fit and manage yourself are also sold without a prescription.²

How well they work

• A review of 8 trials with 787 women found 53% of pessary users reported substantial improvement at 3 months and 32% at 12 months, likely because many stopped using them.²³
• In one trial, a pessary worked about as well as a structured pelvic floor program at 3 months, with similar satisfaction at a year.¹
• The Cochrane reviewers said there’s little controlled evidence and no clear winner between devices.³

Devices are low risk, inexpensive and don’t rule out surgery later.³ Guidelines say a trial of a pessary or insert is reasonable before invasive options, and your preference should guide the choice.¹ Combining a device with pelvic floor exercises is an option too.¹ See our guide to pelvic floor exercises for leaks.

After menopause

Thin, dry vaginal tissue can make devices uncomfortable. A clinician may suggest vaginal estrogen before fitting to lower the risk of discomfort, sores, bleeding or discharge.² Our article on genitourinary syndrome of menopause explains why.

Don’t use a regular tampon

Menstrual tampons shouldn’t be used to treat stress leaks. They absorb vaginal moisture, which can harm the lining.²

Questions for your visit

1. Is my leak stress, urge or both? Devices are for stress leaks. See our guide to stress urinary incontinence.
2. Should I start with a drugstore insert or a fitted pessary?
3. Do I need vaginal estrogen first?
4. How often should I be checked, and who can help if I can’t remove it myself?²

If you also have a bulge from prolapse, our pessary for prolapse guide may help.

Try: “I only leak when I run or lift, and I’d like to avoid surgery. Could a bladder support insert or fitted pessary work for me?”

Laugh, Sneeze, Jump includes an appointment prep sheet. Use it to record which activities cause leaks and how a device changes them.