Managing your Prolapse with a Pessary

What is a pessary?

• A pessary is a soft medical grade silicone device inserted into the vagina that helps to support the walls and prolapse of the uterus, bladder or rectum.

• They are a safe and effective method for management of a vaginal prolapse.

What are the benefits of pessary?

• Pessaries offer multiple benefits including:

• Providing structural support in repositioning the prolapsed pelvic organ(s) into a more anatomical position, thereby reducing the associated symptoms (vaginal bulging, heaviness, bladder and bowel dysfunction)

• Reduce symptoms felt when exercising

• Improve the efficiency of pelvic floor strengthening exercises

• Delay the need for surgical intervention.

• Improved body image and sexual activity

Will the pessary cure my prolapse?

• Think of a pessary like a pair of prescription spectacles. They improve your eyesight while wearing them.

• A pessary will improve your prolapse and prolapse symptoms while it is in place.

• In some cases, wearing a pessary long term may help improve your connective tissue integrity and allow your pelvic floor muscles to strengthen.

Will I feel the pessary when it is inserted?

• You should not feel the pessary if it is the correct size, shape and inserted correctly.

• Sometimes the pessary may move lower during the day. If this happens you can gently push it back up.

• Your health care provider will show you how to do this.

What kind of pessary will I use?

• The decision about which type of pessary each woman should use depends on the type of prolapse and the symptoms it causes.

• The pessary must be properly fitted, which may require multiple attempts. 

• Once fitted, you should not be able to feel the pessary inside your vagina (like a tampon) and the pessary should be comfortable and stay in place during upright activities. You should not have any difficulties emptying your bladder or bowels after a pessary has been fitted. 

Does the pessary cause any side effects?

When using a pessary most side effects of pessary use are mild and easily managed:

• Increased vaginal discharge as your body adapts to the use of a pessary. This will usually lessen over time.

• Mild vaginal irritation can also occur with the initial insertion. This should settle down with ongoing use and your pessary should only be felt if it is not sitting correctly. This can be managed by activating your pelvic floor muscles, readjusting the position with your fingers, or removal and re-insertion.

• Thrush/vaginal yeast infection can occur on occasion. Please see your pharmacist to ask for the appropriate over the counter medication, cease using the pessary for at least 2 weeks, ideally 4 and sterilize your pessary before re-inserting (see below for instructions).

• Onset or worsening of urinary incontinence. This may improve once your body adjusts to the pessary, or with ongoing pelvic floor exercises.

More serious side effects such as the ones below should be reported to your physiotherapist or GP immediately

• Vaginal bleeding – take the pessary out if you are able to and contact the clinic

• Vaginal wall erosion (similar to a graze on the vaginal wall)

• Excessive/smelly vaginal discharge (Bacterial vaginosis) – take your pessary out & contact your GP

• Difficulty emptying your bladder/bowel

• New onset of vaginal or lower abdominal pain.

• On rare occasions a fistula may occur, this is where the pessary erodes the vaginal tissue excessively. (this is why regular follow ups are essential)

Will I need vaginal oestrogen cream?

• If you are post-menopausal and suffer from vaginal dryness you may need to use oestrogen cream to help minimise the side effects and make using the pessary more comfortable.

• If indicated, we will communicate with your GP so that they can prescribe this before pessary use.

• It is important that if you have been prescribed vaginal oestrogen you continue to use it while you are using the pessary.

When does someone not qualify for a pessary managed by a Physiotherapist?

• When someone is unable to comply with follow-up consultations

• If you have an active vaginal or pelvic infection, inflammation, unexplained vaginal bleeding, ongoing vaginal or cervical cancer

• If you have had any radiotherapy to the vaginal tissues or area

• If your vaginal tissue is severely atrophic and you are not responding to pre-pessary oestrogen

• If you are unable to use pre-pessary oestrogen

• You have had previous vaginal mesh surgery

• You are on blood thinner medication such as warfarin

If you have any of the above conditions please discuss with your physiotherapist. There may be a possibility of still using a pessary but under the supervision of a gynaecologist.

Ongoing follow up care

Regular follow up appointments with your physiotherapist and healthcare team are a vital part of pessary management. These are extremely important to help in reducing any side effects and must occur:

• 2-6 weeks post initial fitting

• 6-12 months post initial fitting

• Every 6- 12 months thereafter for as long as you are using the pessary

• The actual pessary device must be replaced every year

If you are unable to commit to the scheduled follow up appointments, pessaries may not be the best management option for you.

Please discuss this further with your treating physiotherapist.

How do I care for my pessary?

• It's important that you follow the specific instructions given to you about caring for your pessary.

Can the Pessary get lost or fall out?

• The vagina is a closed tube thus the pessary cannot move anywhere else within the body.

• A pessary can fall out of the vagina especially if you strain on the toilet, squat down or lift anything heavy.

• If this occurs, it usually means that your pessary is the wrong size and shape, and we recommend seeing your physiotherapist to adjust this.

Can I be sexually active with a pessary inserted?

• Sexual intercourse is generally possible with ring pessaries inserted.

• Cube pessaries have to be removed before.

• Most women do prefer to remove their pessary before sexual intercourse

Can I use a pessary while I am pregnant?

• Please let your health care practitioner know if you are pregnant or planning to fall pregnant.

• A pessary can be used during pregnancy. However, there is a risk of developing bacterial vaginosis, which can cause complications during pregnancy.

• If you would like to use a pessary during pregnancy you will need to be monitored by your obstetrician.

Can I use a pessary while I am menstruating?

• It is completely safe to use your pessary during your period

• You can remove your pessary at night to wash it

• You can still use tampons even with the ring pessary inserted if it is comfortable for you.

Is it difficult to insert and remove yourself?

• Inserting and removing a pessary is very similar to using a tampon or menstrual cup.

• Your health care practitioner will make sure that you are able to insert and remove your pessary yourself and show different techniques on removal and insertion.

What if it gets stuck?

• There is no need to panic if you are struggling to remove your pessary. It is much easier to remove a pessary if you are relaxed and in the right frame of mind.

• You can try sitting on the toilet, relaxing your tummy and pelvic floor, gentle bear down to see if you can gentle remove it.

• If not, contact the clinic where the pessary was fitted and we will be able to guide you on the correct course of action.

Is a pessary the only treatment for prolapse?

Prolapse is not a life-threatening condition. A lot of ladies successfully choose to adopt a “wait and see” approach with their prolapse and adopt lifestyle changes and exercises to best manage their prolapse. Other ladies opt for surgical correction of their prolapse. A pessary may be a good option to try before choosing surgery. Because prolapse is so unique to every individual it is important to discuss all your treatment options with your doctors and physiotherapist.