Pelvic organ prolapse & pessary fitting

10th August 2020

What is a Pessary and why are they used?

Pessaries are used in the management of pelvic organ prolapse or POP for short. Some women wear them all the time and cannot live without them and some women just need a little extra support when doing sport. Pessaries come in lots of different shapes and sizes as do vaginas and are there to support a prolapse; they do not change the tissues.

Pelvic Organ Prolapse is when one of more of the pelvic organs, such as the uterus, bladder or rectum loses its ligamentous support and it drops down into the vagina. Ligament laxity can be caused by a number of things such as, childbirth, aging and pelvic surgery. Changes such as repeated force like a chronic cough or constant straining due to constipation can gradually worsen this laxity over years, not just one or two bouts of coughing or constipation but, continuous difficulty in going to the toilet which is also why we take toilet positioning and bowel health very serious.

What are the symptoms of pelvic organ prolapse?

Prolapse can present as:

  • Backache
  • Lower abdominal ache
  • The sensation of a bulge inside the vagina
  • You might be able to visually see/feel a bulge
  • A feeling of heaviness normally in combination of the above symptoms
  • Some women describe it as a sensation of a heavy tampon falling out.

What happens during an appointment?

The appointment can be between 1-1.5hours long and will include:

  • A detailed history
  • An alignment assessment - how you move, walk, lift, carry, get on and off the bed and out of a chair. We will also look at breathing - how your ribs, diaphragm, stomach move in conjunction with one another and if you have any abdominal separation.
  • An internal examination to assess pelvic floor strength, co-ordination and timing.
  • Measure the prolapse - helps when choosing the appropriate pessary but gives a baseline measurement to compare with in the future.

The consultation may stop there. If your pelvic floor function is more of a priority, then this shall be discussed and you'll be progressed through a bespoke program. If your pelvic floor is not strong enough or functioning well, then a pessary will not stay in. If after the history and examination your physio feels that you might benefit from a pessary, they will begin with the fitting procedure.

There are many different pessaries available but the two most common we use in clinic are a ring and cube pessary. 

Once fitted, your physio will run through a number of movement tests in order to check the position of the pessary Our aim is for it to be as comfortable as possible. You'll be taught how to insert and remove the pessary safely, how to clean the pessary and contraindications you might need to look out for.

Our Physio team recommend seeing you back in clinic the following week for a follow up to discuss how you are doing, check the pessary and answer any questions you may have. Youe pelvic floor program will be progressed if needed, then you'll be booked in to return again normally at 3, 6 and 12 months depending on how you feel.

Are there any side effects?

Most of the potential side effects of using a pessary are low risk however, you do need to be aware of them and how to remove the pessary safely if required:

  • You may notice more vaginal discharge than normal
  • Your vaginal discharge may develop and odour
  • Vaginal irritation
  • Women who are post-menopausal may need to use oestrogen cream
  • If you have bad vaginal odour, lots of discharge or blood you should remove the pessary immediately and contact the clinic. If you can’t get hold of your physio or the clinic then you need to go to your GP.
  • Pessaries generally should not be felt. If you feel really uncomfortable or you have difficulty urinating or passing a bowel movement, then remove the pessary and contact your women's health physio.

Will the pessary fall out?

Many women worry that the pessary can get lost but the vagina is a closed tube. However, the pessary can fall out if you strain on the toilet to open your bowels or if you bend or squat down to lift something heavy. This could mean that the pessary is too small. If your pessary falls in the toilet, try to retrieve it as it can be sterilised and reused but, if you prefer you can just purchase another one.

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