Support Pessaries for pelvic organ prolapse
What is a pelvic organ prolapse or POP?
A POP occurs when one or more of the pelvic organs descend and bulge into the vagina.
Why does a POP occur?
A POP occurs when the supporting tissues in the pelvis and vagina are weakened and organs descend into the vagina, creating a bulge. Individual composition, genetics, pregnancy, childbirth, some types of surgery, obesity, chronic coughs or constipation may contribute to POP.
What are the symptoms of a POP?
POP symptoms may include:
- Vaginal heaviness, bulge sensation, and/or lump protruding from the vagina
- Changes to bladder & bowel function
- Low back ache and discomfort during intercourse.
What are my management options?
Options for a POP management:
- Pelvic floor exercises, taught by a pelvic floor physiotherapist
- Pessaries
- Lifestyle modifications (e.g. weight loss, bowel management, activity modifications if necessary)
- Surgery
What is a pessary?
A pessary is a silicone device inserted into the vagina. It is designed to provide support to help reduce pelvic organ descent. Pessaries come in many shapes and sizes, the most commonly used pessaries by physiotherapists are rings, gellhorns and cubes (see pictures below)
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What are the benefits of a pessary?
- Pessaries are the recommended first line management option for POP, they can help support and lift pelvic organs to provide immediate relief of POP symptoms such as a bulge or heaviness.
- A pessary may be helpful to assist healing and pelvic floor muscle strengthening, particularly in the postnatal period.
- Using a pessary may assist bladder and bowel emptying.
- A pessary can alleviate vaginal symptoms that occur during exercise
- Pessaries may improve body image and sexual function
- Pessaries have been reported to be as successful as surgery to relieve POP symptoms.
- Once inserted you should not notice the pessary
- Nearly all potential side effects of a pessary are reversible with removal of the pessary
Are there any side effects or risks to using a pessary?
There are potential risks but these can be reduced through appropriate fitting and self-care. Side effects may include:
- Vaginal discharge – a small amount is normal.
- Vaginal infections
- New or worsening stress urinary incontinence. This is often temporary and alleviated with pelvic floor exercises but is also completely reversible on removing the pessary. Stress urinary incontinence can also occur after prolapse repair surgery
- Difficulty emptying your bladder or bowel, reversible with pessary removal
- Discomfort or pain this is usually due to the wrong size or incorrect placement and is reversible once removed.
- Vaginal bleeding
- Rarely vaginal wall erosion may occur. Therefore regularly removing your pessary is likely to reduce this risk, but we also recommend you have 6-12 monthly reviews with your GP to check your vaginal tissues. If you require vaginal oestrogen due to hormonal changes during menopause or breastfeeding it is important you continue to use this as prescribed.
Is a pessary right for me?
A pessary is useful if you have a symptomatic pelvic organ prolapse (i.e. prolapse symptoms that bother you) and if you:
- Want to avoid or delay surgery
- Have not finished having your family
- Want to exercise with reduced or no prolapse symptoms
- Have a long wait for surgery
- If you are unable to have surgery
You should always have a vaginal examination by your medical practitioner prior to being fit with a pessary to ensure there are no reasons that you should not have a pessary.
If you have any further questions about being fit with a pessary please do not hesitate to contact us at myPhysioSA for her to find out more.
Call us on 1300 189 289.
Payneham, North Adelaide & Mount Barker.
Written by Leanne Slater.
Leanne is an experienced Women’s Health Physiotherapist.
