Dr. Scott Farrell, the inventor of Uresta, tells all about the inspiration behind his revolutionary, modern device.

As the inventor of Uresta, I get a lot of questions. What’s your background? Why did you invent a pee-leak solution? Why did you name it Uresta? What in the world is a pessary? Urogynecology? Well, I’ve decided it’s time to answer some of these questions.

What’s your background?

I am a Urogynecologist (a physician who specializes in women’s pelvic health), and a professor at Dalhousie University Medical School in Halifax, Nova Scotia, Canada. I did my residency training in Canada, then went on to do a fellowship in Urogynecology and Female Pelvic surgery in Long Beach, California. Eventually, I returned to Canada to set up my clinical practice in a teaching hospital in Atlantic Canada. Over time, I have become recognized as an accomplished surgeon and an expert in my field. But my years of experience treating women with unwanted urinary leakage led me to understand that there was something missing in the treatment options available for women with stress urinary incontinence. That’s when my attention turned to pessaries.

What’s a pessary?

It’s a device that’s inserted into the vagina to help with pelvic organ prolapse and urinary leaks.

Why haven’t I heard of pessaries before?

In the world of Urogynecology there’s a strong focus on using surgery to correct urinary leaks. And in my four years of medical school training, pessaries were never mentioned. They were considered by most of my teachers and colleagues to be antiquated devices from a bygone era. We were trained to be surgeons and to treat problems the modern way: with surgery. And while surgery is a great option for some, not everyone wants to undergo it, or can afford it.

What were historical pessaries like?

Early pessaries were fashioned from natural materials, such as wax balls, fruits like pomegranates, and cloth. Some were even carved from wood or fabricated using other natural materials. They’ve been in use for thousands of years. But, of course, complications arose when these materials were placed inside the body.

It was a long time before modern pessaries entered the scene. And when vulcanization was developed, rubber pessaries could be mass-produced by companies and provided to medical professionals.

These days, pessaries are made of inert thermoplastic elastomers or silicone.

Examples of early pessaries.

Is Uresta the only pessary that people still use today?

No, there are others called ring pessaries but, as I discovered, they have their drawbacks. Firstly, they must be fitted by a doctor. And while a small percentage of our patients could take care of their ring pessaries themselves, the majority had to come back for regular visits to have their pessary removed, cleaned, and re-inserted.

That’s why I wanted to create an easy, at-home solution for women that actually works.

How did you turn your inspiration into the actual Uresta product?

I set about developing a rudimentary design for my user-friendly pessary. Inspiration based on my clinical medical knowledge, and plasticine models I created, resulted in the first Uresta prototype! I then received Health Canada regulatory approval to conduct an investigational clinical trial of my invention to test its effectiveness and safety. The clinical study showed that the Uresta worked safely to successfully treat stress incontinence and that women welcomed it.1 Clinical experience with Uresta and other research about Uresta have confirmed this success.2,3

How is Uresta different from other pessaries?

Uresta lets women take control of their own pee-leak solution. They don’t have to go to the doctor to get it fitted, and they can insert it/remove it at home as the tapered end of Uresta allows for easy insertion into the vagina. And the bell shape means that the widest portion sits under the urethra, providing necessary support. The design also prevents Uresta from rotating out of place. The handle allows women to control Uresta as it’s inserted, and to grasp it for easy removal. And last, but not least, it’s comfortable!

Why did you call it Uresta?

The word “Uresta” can be broken up into 3 parts: “ur” represents the problem of urine leaks, “rest” represents the rest from pesky urine leaks, and “ahh” represents the sigh of relief women express when they are no longer worried about leaks.

1.Farrell SA, Baydock S, Amir B, Fanning C. Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women. Am J Obstet Gynecol. 2007 May;196(5):474.e1-8. doi: 10.1016/j.ajog.2006.11.038.PMID: 17466709

2. Lovatsis D, Best C, Diamond P. Short-term uresta® efficacy (SURE) study: a randomized controlled trial of the Uresta continence device. Int Urogynecol J. 2017; 28(1):147-150.

3. Gallagher L, Woodcock D, Massey L. Product Reviews. Journal of Pelvic, Obstetric and Gynaecological Physiotherapy. 2019; 124: 63-66.

In our last blog, we talked about the anatomy and function of the pelvic floor or Kegel muscles.  We discovered that both male and female bodies have three LAYERS of muscle with multiple muscles in each layer. And that these muscles provide the following functions in our bodies:

1. Supportive: of the pelvic organs (bladder, rectum, uterus, prostate)
2. Sphincteric:  opening and closing of the urethra, vagina and anus
3. Sexual:  contributing to arousal and orgasm
4. Stabilizing:  with a host of other muscles pelvic floor contributes to stability of trunk, pelvis and hips
5. Posture:  maintains good posture along with back and abdominal muscles
6. Breathing:  the pelvic floor and your main breathing muscle, the diaphragm, coordinate together
7. Pumps fluids: contraction and relaxation of pelvic floor muscles supports the flow of fluids in the body

Today we are going to learn about how pelvic floor function relates to pelvic organ prolapse (POP) and stress urinary incontinence (SUI). 

Pelvic Organ Prolapse is a condition where your internal pelvic organs (bladder, uterus, rectum) have shifted position and lean toward the vagina.  This usually happens because the ligaments and support tissue that hold the organs in place have been stretched.  People with prolapse often have a sense of a bulge in the vagina or difficulty emptying their bladder or bowel.  The pelvic floor muscles can also play a role. Strong muscles might help support the displaced organ, while weak muscles might lead to more symptoms. You can read more about pelvic organ prolapse here.

 

Stress Urinary Incontinence (SUI) happens when you accidentally leak urine when you cough, sneeze, laugh, lift, jump, run or otherwise experience an increase in intraabdominal pressure.  The urethra (tube from your bladder to the outside of you) doesn’t stay closed and some urine escapes.  This condition is often referred to as light bladder leakage and some women refer to SUI as their “mommy bladder,” reflecting the fact that childbirth often contributes or causes SUI to develop. 

 

A good analogy for SUI is a leaky faucet. It would be that the valve is just not closed all the way (weak muscles) or perhaps it is broken and unable to close (structural changes).  In the same way, there are various reasons why the urethra does not fully close and contributes to urine leakage. 

What causes bladder leakage related to stress urinary incontinence? There can be many factors that contribute to bladder leakage such as:

1. Being overweight
2. Straining with constipation
3. Vaginal childbirth where you pushed for more than 2 hours or less than 30 minutes
4. Vaginal childbirth with forceps
5. Having multiple pregnancies and deliveries
6. Having twins, triplets etc.
7. Giving birth at an older age
8. Damaged nerves
9. Pelvic surgery
10. Certain medications like diuretics or water pills

You can read more about stress incontinence here.

You might think that only nonfunctioning or weak muscles would present with the symptoms of stress incontinence or prolapse, but I can tell you from many years of experience that I have seen a range of muscle presentations with these symptoms. For example, often times women with leakage or prolapse develop a habit of habitually tightening their pelvic floor muscles which can lead to overactivity, pain and muscles that don’t function well.  

We will talk about the difference between and importance of pelvic floor strengthening or kegel exercises, relaxation, and coordination in a future blog! 

Wouldn’t it be helpful to know how YOUR pelvic floor muscles are functioning! 

A specialty trained pelvic health physical therapist can evaluate the state of your muscles and organs and provide a customized treatment program to meet the needs of your body.  Muscles can be trained through physical therapy to improve in function regardless of their current state.  

Now here’s some really good news. Uresta works regardless of pelvic floor muscle function and can provide immediate support to your organs, ligaments, and connective tissue.  Uresta works in theory like an ankle brace. Image you had a bad ankle sprain but really wanted to get back to running.  An ankle brace could support your body while you are working on your recovery.  The ankle brace might be something you use short term, or just as needed.  Or, maybe the injury to your ankle was more severe and using the brace may be an important part of your daily self-care.  

Use of Uresta to support the bladder and urethra works much the same way. Some people may use it just for exercise, while others will find the most benefit using it on a daily basis. Easily inserted vaginally, Uresta helps to keep the urethra closed and the bladder supported with increases in intraabdominal pressure, so that you can do the things in life you love without worrying about prolapse or leakage.  

There is no reason for women to suffer in silence with pelvic floor dysfunction, prolapse, or stress incontinence.  Help is available!  

An Introduction to Pelvic Floor Anatomy and Function in Women & Men

The Pelvic Floor is finally starting to get the press it fully deserves in our culture.  As a Physical Therapist who specializes in pelvic health, I often see magazine articles, websites and new products being developed to help educate, empower and support pelvic floor function.

But I am willing to bet that most of us are not very familiar with the unique architecture and function of this remarkable part of our body.  Read on for an anatomy lesson on the pelvic floor and learn about all the important bodily functions it plays a key role in.

The pelvic floor complex is comprised of 10 muscles in female bodies and 8 muscles in male bodies that are formed into three layers.  The following is a tour through each of those layers’ structure and function.

Functions of Your pelvic floor muscles

1. Supportive
2. Sphincteric
3. Sexual
4. Stabilizing
5. Posture
6. Breathing
7. Pumps Fluids

 

Layer 1: Muscles that support sexual and support functions

In female bodies, layer one pelvic floor muscles support the vaginal and anal openings by forming the band of tissue between the vagina and the anus (perineum).  These muscles help with blood flow to the clitoris during arousal and hug the vaginal opening.

 

These muscles are often injured or torn during vaginal childbirth. 

In male bodies, layer one is also helpful for sexual functioning by maintaining erection, plays a role in urination, and provides muscular support to the area between the testicles and the anus (perineum).  Weakness in these muscles can contribute to urinary leakage and erectile dysfunction.

In both male and female bodies, the external anal sphincter is also part of layer one muscles.  The anal sphincter plays a big role in coordinating defecation.

 

 

 

Layer 2: Muscles that coordinate and control urination

Female bodies are more prone to issues with urinary incontinence for several reasons:  they lack a prostate gland, have a shorter urethra, may experience the stress and strain of pregnancy and childbirth, and lose estrogen which may negatively affect continence.  Luckily, the second layer of pelvic floor muscles offers some compensation for this.  Male bodies have just two muscles here, while female bodies have four that offer additional support around closing the urethra.

These muscles may be weak, poorly coordinated, or overactive which usually presents as urinary dysfunction:  leakage, urgency, spraying, dribbling.

 

Layer 3: Muscles that support our pelvic organs

The third layer is relatively the same in both female male bodies and is busy with many functions.  These muscles provide support for the pelvic organs (bladder, urethra, rectum and prostate in male bodies; bladder, urethra, vagina, uterus, and rectum in female bodies).    They are important for sexual functioning and orgasm.  The third layer of pelvic floor muscles also join in with a network of other muscles of the body to provide postural stability, coordinate with the diaphragm (the main breathing muscle) to assist in breathing, and even form a kind of pump to help move blood and fluids from the lower body back to the heart.

 

This layer is susceptible to stretch injury from pregnancy and childbirth, weakness from chronic straining (lifting, coughing, constipation), problems from nerve damage or surgery, and structural weakness that happens with loss of estrogen.

Overactivity in this layer can occur with chronic pain, trauma, musculoskeletal problems like low back or hip pain, surgery, clenching/stress and tension, and tailbone injuries.

Your hip bone’s connected to your …

There is one more muscle I’d like to highlight, that isn’t exactly a pelvic floor muscle but sometimes gets called part of the pelvic WALL.  This muscle is interesting and unique in that it is actually a HIP muscle and it’s job is to externally rotate and stabilize the hip joint.  BUT it literally attaches right into the pelvic floor.  Sooo your hip bone IS attached to your pelvis just like the old song says!

This image shows the view of the pelvic floor looking from above.  You can see the Obturator Internus muscle outlined in blue (with arrows) and the third layer of the pelvic floor outlined in red.

Research has found that this muscle is also an important factor in pelvic floor function and via it’s anatomy, it links hip and pelvic function.

Studies in both female and male bodies show that exercising this muscle can be just as effective as exercising your pelvic floor in relieving stress urinary incontinence or accidental urine leakage.

I bet you just got a pretty good education on a part of your body you didn’t know much about!  In our next blog we’ll talk about how problems in pelvic floor muscle function occur and the symptoms this can cause.

If you like learning, stay tuned for future blog posts covering topics like …

• What happens when there is pelvic floor dysfunction?
• Why pelvic health is more than just kegels.
• What can I do about incontinence?
• What is pressure management and why is it important?
• What’s a prolapse? And do I need surgery?
• What’s all the fuss about constipation?
• …. And much more!

Who is Jennafer Vande Vegte MSPT, BCB-PMD, PRPC?

After graduating from Ithaca College, Jennafer began her career as a physical therapist at Spectrum Health in Grand Rapids, MI. Since 2002 Jen has focused her professional attention on treating women, men and children with pelvic health disorders. She is energized through education and enjoys her position as adjunct faculty at Grand Valley University, speaking at community events, organizing a regional pelvic floor mentorship and study group, and didn’t necessarily enjoy but survived part time home schooling her two daughters. She has been faculty for Herman and Wallace Pelvic Rehabilitation Institute since 2009 and loves to inspire other rehab professionals treating pelvic floor dysfunction. She is an author of the chapter, “Manual Therapy for the Pelvic Floor” which was published in the book, “Healing in Urology.” Jen was a contributing writer for the Pelvic Floor Capstone and Oncology and the Pelvic Floor for Herman and Wallace and also co-authored the continuing education course, “Boundaries, Self-Care and Meditation” with Nari Clemons. She is certified in pelvic floor rehabilitation and biofeedback for pelvic floor disorders. Outside of teaching and treating patients, Jen loves to spend time with family and friends, run, cook, travel, do yoga and snuggle with her doggo.