Pessary Care Is The Next Step in Pelvic Rehabilitation

Pelvic health rehabilitation has grown tremendously over the decades, expanding from a publicly viewed mentality of “just Kegels” to a comprehensive, whole-body, and whole-life approach. As rehabilitation providers, we now treat the complex interplay of muscles, fascia, organs, and the nervous system that influences bladder, bowel, and sexual health. But one area that is still underrepresented in many rehabilitation settings is pessary care.;

Pessary fitting has historically been performed by gynecologists and urogynecologists, but in more recent years, especially since the APTA released a position statement in favor of pelvic health physical therapists being able to fit pessaries in 2022, pessary care has entered the rehab scope of practice. Adding pessary fitting, management, and follow-up into a pelvic rehab practice can provide immense benefits for patients, providers, and the healthcare system at large.

Pelvic organ prolapse (POP) is incredibly common, affecting nearly half of people who have given birth. As pelvic health providers, we are not surprised to hear many patients are left with only two extremes: surgery or “wait and see.” We know that pelvic floor therapy can help POP, with things like lifestyle changes, bowel/bladder habit changes, support garments, pressure management, and exercise, but what about our patients who need more?

Pessaries provide a non-surgical, reversible, and evidence-based option that can dramatically improve symptoms of prolapse and stress incontinence. Pelvic rehab providers have been happy to provide traditional therapy options, but now we’re able to offer the additional option of pessary care if we have the right training and permissions from our licensing and state boards. Pelvic health rehabilitation providers already assess pelvic floor function, educate patients on anatomy, and provide individualized exercise programs. Integrating pessary fitting for appropriate patients is a natural progression or addition of this care.

Most of our patients are seeking pelvic therapy because they want to get back to the activities that matter. They come in with goals like running after their kids, practicing yoga without leakage, enjoying intimacy, or simply walking without pressure or heaviness. A pessary can act like a structural support “orthotic” for the pelvic floor, allowing therapy exercises to be more effective, reducing discomfort, and helping patients meet their functional goals faster. The amazing part about pessaries is that they can be used as short-term solutions, like for a run, or an all-day solution, like with a patient who stands for a 12-hour shift.

Why don’t pelvic rehabilitation providers just wait and refer to the “experts” for pessary fittings? Appointments with urogynecologists or surgeons can require long wait times, travel to urban centers, or may not even exist in rural areas. There is a possibility of higher expenses if a person goes to a larger facility and has a high deductible. In other countries (like Australia, Canada, France, and Germany, to name a few), rehab providers are the primary pessary fitters! And even in the US, there are many therapists who have been fitting pessaries for years, usually under the training and guidance of gynecologists or urogynecologists.

When rehabilitation providers offer pessary care, this expands access to conservative treatment for all patients, but especially those with less access to pessary care due to financial, scheduling, or access issues. For patients who feel dismissed in or apprehensive of traditional medical settings, the supportive, education-focused, trauma-informed environment of pelvic rehab can also reduce anxiety and improve outcomes.

Patients often see their pelvic rehab providers weekly, developing strong trust and rapport. This relationship may make a patient more open to learning about pessaries, asking questions, and following up regularly for fit checks and care. Integrating pessary education and management strengthens that continuum of care, reducing the drop-off that can occur when patients are bounced between multiple providers. Be mindful that fitting pessaries is an art and comes with a need to have a medical provider looped into the patient’s plan of care. Medical providers can help manage any potential skin issues, discharge issues, or infection. There will also be times when a rehabilitation provider does not have the skill set to meet the needs of a patient, and the patient needs to be referred to a more skilled or advanced provider.

For therapists, adding pessary care is not just about tools; it is also an opportunity for professional growth. Pessary fitting requires advanced clinical reasoning, commitment to whole-patient solutions, and adaptability to evolving best practices. From a business standpoint, it allows a clinic to differentiate itself, attract new referrals, and provide a comprehensive service that keeps patients within its continuum of care longer.

Current research shows that pessaries are safe, cost-effective, and highly acceptable to patients. Professional organizations (such as the APTA Academy of Pelvic Health and AOTA) recognize the need for interdisciplinary, conservative options in managing POP and incontinence. By adopting pessary care, rehab providers position themselves at the forefront of evidence-based pelvic health practice.

Ultimately, pelvic rehab is about giving patients the knowledge and tools to take ownership of their health. Implementing pessary care provides one more option, whether used as a long-term solution, a bridge to surgery, or a way to stay active and comfortable during postpartum recovery, high-impact activity, or menopause.

Adding pessary fitting to our skill set is not about replacing what we already do as pelvic rehab providers. Fitting pessaries can enhance our provider toolkit, help us collaborate with other providers, and meet patients where they are. When used alongside education, exercise, and behavioral strategies, pessaries can be life-changing. By implementing pessary care, pelvic rehab providers honor the true spirit of our profession: addressing the whole person, restoring function, and empowering patients with choices beyond the “surgery or nothing” dichotomy.

Take the Next Step: Learn Pessary Care in Practice
If you’re ready to expand your clinical toolkit and bring the benefits of pessary care to your patients, join us for Pessaries and Pelvic Rehab: Introduction to Pessary Fitting, Care, and Management.

This two-day, in-person continuing education course is designed for experienced pelvic rehab providers who want to integrate pessary fitting into their practice. With a blend of pre-course lectures and hands-on lab instruction, you’ll gain the advanced assessment skills, fitting techniques, and clinical reasoning tools to confidently and safely implement pessary care.

Upcoming Course Dates & Locations:

• Chicago, IL | November 8–9, 2025
• Tacoma, WA | January 31–February 1, 2026
• Houston, TX | September 12-13, 2026

This course features pre-course anatomy and POP modules, lab-based POP and vaginal dimension assessments, supervised pessary fitting practice, and a pessary fitting kit included with registration. Give your patients more options, strengthen your scope of care, and be part of the growing movement to integrate pessary care into pelvic rehabilitation.

AUTHOR BIO:
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey, and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, she opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.