pessaries: conservative management of pelvic organ prolapse
A pessary is a small silicone insert that supports the organs in pelvic organ prolapse. What pessaries are, who they help, and how to use one well.
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Today we want to dive into pessaries; what they are, who they are for and how to use them effectively. To understand what a pessary is we first need to understand and define pelvic organ prolapse (POP).
What pelvic organ prolapse is
POP is when an organ that lives in the pelvis descends or moves lower in the body due to disruption or lengthening of the structures holding them in place. POP is typically experienced in women after childbirth as well as during menopause. POP is generally caused by a multitude of factors but include:
- Vaginal childbirth
- Instrument assisted childbirth
- Increase BMI
- Chronic coughing
- Heavy lifting
- Hormonal changes and weakening during menopause
POP will cause a sensation of heaviness in the vagina, create a bulging sensation as well as a visible bulge in the vagina. In some cases can cause difficulty voiding, stress urinary incontinence, pain with intercourse and chronic UTIs.
While POP at first glance can seem scary and overwhelming, a majority of women can find relief and freedom through conservative management - including pessaries!
How prolapse is treated
While surgical procedures do exist and can help some instances of prolapse, we find so many women are able to find freedom with pelvic floor physical therapy as well as pessaries.
Pelvic Floor Physical Therapy is a first line of defense for prolapse that includes muscle training of the pelvic floor (the muscles that support the organs) as well as learning lifestyle modifications, bladder/bowel health, strength training and exercise. Pessaries are also a wonderful option for people looking for extra support and symptom management.
What a pessary does
A pessary is a silicone device inserted into the vagina in people experiencing prolapse. The pessary acts as scaffolding or support to our organs and fascia. There are many different types and shapes or pessaries that provide different types of support depending on a person's anatomy and type of prolapse.
Pessaries can be used short term as women gain strength in the pelvic floor and allow structures to heal. Others use pessaries long term to decrease their sensations of prolapse, allowing them to live life without fear or bothersome symptoms!
Types of pessaries
There are 2 main types of pessaries we look at when treating prolapse. The first type of pessary is called a Support Pessary. Support pessaries are inserted and sit on top of a woman's pelvic floor muscles providing a solid “floor” for the organs sitting above it. The most popular type of support pessary is a ring pessary.
The second type of pessary available is a space occupying pessary. These are more bulky and generally come in 3D shapes like cubes or donuts. These will utilize suction on the vaginal wall to stay in place.
Each type of pessary can also come with knobs or specialized shaping to provide extra support to the urethra and/or rectum depending on a person’s symptoms.
How to get fitted for a pessary
A woman needs to be fitted for a pessary and we do that right here at PeakRx! We first will perform an initial consultation to discuss your history, symptoms and goals. A full pelvic floor exam is performed in order to check your prolapse, strength, coordination and resting position of your tissue. All of these are considered when deciding if you are appropriate for a pessary and then which one will fit your body the best!
The full pessary fitting is performed at your second visit. Your therapist will use their index and middle finger internally to measure your tissue and insert the pessary. You will then stand up, move around and even go to the bathroom! A properly fitting pessary shouldn’t cause any discomfort or pain. If it does, another pessary will be attempted until the right fit is found.
After identifying the ideal pessary, your therapist will instruct you on proper insertion and removal and have you practice yourself. We want you to feel confident in managing your pessary at home.
We then will schedule a follow up for 1 week later to check in on your progress and symptoms. At that point, you and your therapist would decide on a plan to continue to rehab and heal your prolapse!
Reach out to us if you are curious if pessaries are right for you to help manage your prolapse or leakage!
This article is for general education and isn't medical advice. For guidance on your own symptoms, talk with your doctor or a physical therapist.
Dr. Brooke Miller
Physical Therapist / Owner
Owner and physical therapist specializing in orthopedic and pelvic health physical therapy.