Pessary for Prolapse: Could Pessaries be a Game Changer for your Pelvic Organ Prolapse?

Pessaries aren’t new, in fact they date back to the days of Hippocrates, and their use have even been documented in early Egyptian parchment. It’s pretty amazing that women were trying to find ways to ease vaginal prolapse symptoms even then!

But what is a vaginal (or pelvic organ) prolapse I hear you say?

Vaginal prolapse or pelvic organ prolapse is when the vaginal walls (front and/or back), cervix or ‘roof’ (in women following hysterectomy) bulge downwards towards the vaginal entrance. Vaginal prolapse is common, affecting up to 1 in 3 women. It is more common in women who have had a vaginal birth, but C-section mums and women who have never had children can also be affected. Women often complain of vaginal heaviness, pressure, bulge or general discomfort, with or without associated urinary symptoms.

It makes sense to want to use something to better support these feelings and there are now a huge range of vaginal pessaries available for women to use to do just that. The type of pessary required will depend on the types of vaginal prolapse someone may have.

How will I know if I have a prolapse?

Lots of women will have a mild prolapse and have no symptoms, which is nothing to be concerned about. Some may be told, commonly during a medical examination such as a smear test, that a prolapse has been identified. Other women may notice an obvious bulge or feeling a heaviness after exercise, carrying their baby on a long walk or going to the loo for example. Vaginal prolapse in itself is not a concern, but if it is impacting on your ability to do the things you want to do (including sexual intercourse), giving you unwanted heaviness feelings or impacting on your ability to empty your bladder or bowels, then it is advised to have a specialist assessment and get things checked.

There are different types of prolapse and different gradings of severity which generally impact on the symptoms someone would experience and what vaginal prolapse treatment options would be most suited to them.

What is a pessary and when would it be useful?

A pessary is a plastic or silicone device that is inserted into the vagina to support the displacement of the vaginal walls as described above.

A pessary is recommended for vaginal prolapse symptoms either as a stand-alone option or more often recommended with prolapse physiotherapy and supervised pelvic floor exercises (NICE 2019).

Below is an image of a ring pessary within the vaginal space (taken from UKCS.org)

 

 

When is a pessary indicated?

Vaginal pessaries can be useful if pelvic floor rehabilitation has plateaued, or additional support is required internally. Vaginal prolapse exercises are key to bulk up these important muscles in addition to the timing of how well they able to activate and release. Women with vaginal prolapse or urinary incontinence often also benefit from rehabilitation of the body as a whole and training the body specifically in relation to the demands placed upon it, such as running, jumping and changing direction.

Some women only use a pessary for certain activities such as exercise, playing a competitive sport or long periods on their feet. Whilst other women need a pessary every day to give them the relief in symptoms that they need. Both are very good options.

 

 

Unfortunately, some women (especially younger women) only try using a ring pessary which may not relieve symptoms, be uncomfortable or fall out. These are the sorts of comments I hear in clinic from my patients:

Do any of these statements sound familiar?

“Isn’t a pessary only for very elderly women?”

“I thought surgery was the only option for my prolapse?”

“Isn’t prolapse something that I should put up with, especially after having a baby?”

“I’ve been told I can’t exercise with prolapse or run again!”

“I don’t want to have to go back for my pessary to be changed every 6 months so I don’t want to try one”

These are all myths associated with prolapse and vaginal pessaries. For most mild to moderate vaginal prolapse, conservative management combining pelvic floor physiotherapy and/or pessary use can significantly improve symptoms. This is good news for women!