Pessaries: Everything You Should Know
If you have pelvic organ prolapse or urinary incontinence, you know how debilitating it can be! You may have also heard that surgery is the only way to get a long-term fix. Although pelvic health physical therapy can be very helpful for many people with prolapse and leakage, it’s not always enough! That’s why we’re happy to announce that GWP Physical Therapy is now offering pessary fittings in order to give you more treatment options for prolapse and leakage.
What is a pessary?
A pessary is a medical device that can be inserted into the vagina to help support organs that are dropping down (as with pelvic organ prolapse) or to support a bladder that’s leaking. They come in a variety of shapes and sizes and are made of medical-grade silicone or plastic. Common shapes include rings, cubes, and cups, but there are many different types that can be personalized to fit your issue! The shape and material used are dependent on your body type, previous birth history, pelvic anatomy, and the type of prolapse or leakage. While inserted, they help to hold the pelvic organs in place to decrease feelings of pressure and heaviness, discomfort, and improve bladder and bowel function.
Why choose a pessary?
In cases of severe prolapse or leakage, pelvic physical therapy may not be enough to resolve the issue. Surgery is often considered the only other option; however, many people don’t want the risks of surgery or mesh placement and there is always the risk of recurrence or complications. A pessary is an excellent conservative option if you wish to avoid surgery. Pessaries can also be used as a testing device to predict if a surgery will be successful or not1. In addition, pessaries are far more affordable than surgery, especially in the absence of insurance.
Why choose a pessary?
In cases of severe prolapse or leakage, pelvic physical therapy may not be enough to resolve the issue. Surgery is often considered the only other option; however, many people don’t want the risks of surgery or mesh placement and there is always the risk of recurrence or complications. A pessary is an excellent conservative option if you wish to avoid surgery. Pessaries can also be used as a testing device to predict if a surgery will be successful or not1. In addition, pessaries are far more affordable than surgery, especially in the absence of insurance.
How do you know if a pessary is right for you?
In situations where a pelvic organ prolapse is more severe, you may experience symptoms like feelings of pressure and heaviness in the vaginal area, seeing a “bulge” at the vaginal entrance, trouble fully emptying your bladder or bowels, leakage, and difficulty with sexual intercourse. Unfortunately, in cases where the prolapse has descended past the vaginal entrance, doing pelvic floor strengthening alone is not enough to treat the problem. The research shows us that in severe cases, patients have better outcomes when we combine pessary use with pelvic floor strengthening and may even decrease the stage of the prolapse4. Pessaries are also more effective for patients who are not seeing improvement in their leakage, even after attempting pelvic floor physical therapy.
When deciding if a pessary is right for you, we do a full evaluation. This includes a pelvic exam to assess the type and severity of prolapse or the underlying reason for your leakage. We take measurements to fit you for an appropriate size and shape of pessary, and we may even be able to try out the pessary in that same treatment visit! We’ll make adjustments on the size and shape until we find one that’s just right for you.
How do pessaries work?
A pessary can be fitted and inserted in-clinic without a surgery. They are designed to be easily inserted and removed by either the patient or the clinician. Depending on the type of pessary, they may be left in for up to several months at a time without needing to be removed. Our pelvic physical therapists are trained to assess and fit a pessary that is specific to your type of prolapse or leakage and will work well with your lifestyle.
Maintenance and Care of Pessaries
If you decide to get a pessary, how do you take care of it? It’s important to know that the maintenance of your pessary depends on what type you end up with. For example, ring-type pessaries may often be left in for months at a time, with regular checkups every 3-6 months in order for your medical provider to remove, clean, and reinsert the pessary while checking for any tissue irritation or breakdown in the vaginal canal. However, a cube-type pessary must be removed every 1-2 days by the patient to clean it and give your vaginal tissue a break. Any preferences or difficulties with inserting or removing pessaries will be considered when determining what type of pessary is right for you.
In general, the pessaries can be washed with regular soap and water and don’t require any specialized cleaning equipment.
Frequently Asked Questions:
Does a pessary hurt?
No! While inserted, you should not feel the pessary at all.
Can I have sex with a pessary?
It depends on the type of pessary – some types, like the ring, allow for penetrative intercourse while the pessary is inserted. Others, like the cube, must be removed before participating in penetrative intercourse.
Can I pee with a pessary inserted?
Yes, you should be able to both pee and poop with a pessary in (and ideally it will improve the function of both!)
Will this fix my prolapse?
A pessary is not “fixing” the prolapse, simply creating support for the organs to provide short or long-term symptom management. However, there is research that suggests that in some cases, long-term pessary use may lead to an improvement in prolapse stage and severity2, 3.
Can I insert and remove the pessary on my own?
It depends on the type of pessary – ring and cube pessaries can often be inserted and removed by the patient as needed. Other types of pessaries may require regular visits with a clinician to remove, wash, and re-insert.
Meet ourTherapist
Schedule an Appointment Today
If you’re dealing with pelvic organ prolapse or leakage, you should know that you have options. Our pelvic therapists will do a full assessment to determine if a pessary is right for you. Make an appointment with us today!
Citations
- Liang CC, Chang YL, Chang SD, Lo TS, Soong YK. Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstet Gynecol. 2004 Oct;104(4):795-800.
- Miceli A, Fernandez-Sanchez M, Duenas-Diez JL. How often should ring pessaries be removed or changed in women with advanced POP? A prospective observational study. Int Urogynecol J. 2021 Jun;32(6):1471-1478.
- Mendes LC, Bezerra LRPS, Bilhar APM, Neto JAV, Vasconcelos CTM, Soboia DM, Karbage SAL. Symptomatic and anatomic improvement of pelvic organ prolapse in vaginal pessary users. Int Urogynecol J. 2021 Apr;32(4):1023-1029.
- Bugge C, Adams EJ, Gopinath D, Stewart F, Dembinsky M, Sobiesuo P, Kearney R. Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database Syst Rev. 2020 Nov 18;11(11):CD004010.