If you've been told you have pelvic organ prolapse—or you're experiencing symptoms such as a feeling of pressure, heaviness, something coming down inside, or a bulge in the vagina—you may have heard about a vaginal support pessary. While the name may sound unfamiliar, a pessary is a well-established, non-surgical treatment that has helped millions of women manage prolapse and improve their quality of life. Additionally, a pessary can also be used to help manage stress urinary incontinence (Leaking urine when you are doing an activity such as a cough/sneeze/exercising).
What Is a Pessary?
A pessary is a removable medical device, usually made from soft, flexible silicone, that is inserted into the vagina to provide support to the pelvic organs. It helps hold the bladder, uterus (if you have one) rectum, or vaginal walls in a more natural position when the muscles and ligaments that normally support them have weakened, stretched or been injured. Pessaries come in a variety of shapes and sizes, including ring, cube, Gellhorn (looks a bit like a spaceship/mushroom), and donut designs. Some of them have a knob on it to help support the urethra (the tube from your bladder) for continence. Because there are so many shapes and sizes, a highly trained health care practitioner must first perform an examination and fitting to determine which one is right for you and your anatomy.
How Does a Pessary Work?
Think of a pessary as an internal support device or “scaffolding”. Once inserted, it gently lifts and supports the pelvic organs. This not only relieves symptoms (when successfully fitted) but can also may help prevent further stretching of the already stretched or injured pelvic fascia overtime. Many people also report improved ability to perform their rehabilitation exercises for their pelvic floor muscles with the pessary.
Who Is a Good Candidate?
A pessary may be a good option if you:Want to avoid or delay surgeryAre not a suitable candidate for surgery because of other medical conditionsWish to remain active while managing prolapse symptomsWant a reversible less invasive treatment optionWant to try to prevent worsening of their symptomsMany people use a pessary successfully for years, while others use one temporarily before surgery or during recovery after childbirth. Some people are also now choosing to use one post-partum to help return to exercise with a little more “support”.
What Is the Fitting Process Like?
Due to the myriad of shapes and sizes and the risks involved, a pessary should be fitted by a qualified healthcare provider. At Hollyburn Physiotherapy Clinic, your safety and comfort are paramount, therefore we have an established and evidence based and efficient fitting and follow-up regime that also involves your primary care provider. We also want to ensure you are fitted with the best option and are not spending excess $$$ buying and trying different pessaries.
The process is as follows:
- An initial 30 minute appointment (can be virtual if preferred) will be booked to discuss your history, goals, the fitting process, the risks and benefits of pessary use, and ensure you are appropriate to proceed with a fitting.
- Following this, a letter will be sent to your primary care physician or nurse practitioner.
- A 60 minute fitting appointment will be booked following this. During this appointment, we will review the risks/benefits and appointment structure. A vaginal examination (with your consent) will be performed to assess your pelvic floor function as well as determine what shape and size pessary’s to try.
- We will then fit up to 3 pessary’s (we don’t do more as there can be stress on the vaginal/vulva tissues when fitting more). You will be asked to do certain movements with each pessary inside, as well as go to the bathroom to void with the pessary in. This is to determine if the fit is appropriate. When we find one that works, we may have it in stock for you to get that day, or advise you on how to order it or where to pick it up. We may also discuss pelvic floor rehabilitation and lifestyle advice with you at this appointment.
- Note that although we do our best to find a pessary that works the first time, sometimes more than one fitting appointment is required.
- A 30 minute follow-up appointment is mandatory following a 2-3 week period of use with your pessary. This is to ensure that the pessary is working for you and to make sure that your tissues remain healthy and there are no concerns. Depending on whether you are self managing your pessary or working with your health care provider to manage it, the appointment schedule for follow-ups may differ. Due to the nature of the pessary fitting process, you will need to call the clinic to book your appointments.
Frequently Asked Questions:
Is a pessary the only way to manage pelvic organ prolapse, besides surgery?
No! Pelvic floor physiotherapy and lifestyle modifications can also help with symptoms of pelvic organ prolapse. We will discuss these with you at your appointment.
Can you feel the pessary when you wear it?
Generally, if a pessary is fitted appropriately, most people do not feel a pessary once it has been inserted, similar to a tampon.
Can I have sexual intercourse with a pessary?
This depends on what pessary you have been advised to use. Ring pessary’s are the only type that can stay inside during sexual intercourse; however, many people choose to remove them. Other pessary types must be removed before intercourse. If you are self-managing your pessary you can do this yourself and re-insert it after.
Can I leave my pessary in when I’m on my period?
It is advisable that you remove your pessary at least once every 12 hours while you are menstruating to clean it. Many people choose to leave their pessary out during menstruation as it can stain the pessary. Does everyone find a pessary that works? Unfortunately, not everyone has success with a pessary. There are many different reasons for this. In the scientific research, it is estimated that 70-90% of people with pelvic organ prolapse have success with a pessary, and 30-50% of people with urinary and bowel symptoms have relief and success with a pessary.
Can a pessary be covered by insurance?
Every insurance provider and plan is different. Many insurance providers do cover the cost of your pessary appointments and the pessary itself. To help with this, when the consent letter is sent to your primary care physician/nurse practitioner, we request a pessary prescription which you can then use towards your insurance.
How much does it all cost?
All in, the cost for your initial assessment, pessary fitting appointment, the pessary and first follow-up is approximately $500.
Francesca Ruddick
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