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Prolapse and Pessary management

Pelvic organ prolapse (POP) occurs when either the bladder, uterus/cervix, or bowel, move downwards into the vagina, due to reduced fascial or pelvic floor muscle support. Prolapses are graded from 1 (mildest) to 4 (most severe). Your symptoms may not always match the grade — every woman is different. What matters most is how you feel. 

There are different ways to manage prolapse, one option we offer in clinic is pessary self-management.

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​A pessary is a removable silicone medical device that acts as a support within your vagina, helping to hold your pelvic organs in place. By providing this support, prolapse symptoms can be reduced or eliminated. They stay in the vagina and cannot migrate elsewhere. Pessaries come in different types, sizes, and shapes.

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Benefits of a pessary:

  • Non-surgical 

  • Custom fitted 

  • Removable and adjustable

  • More affordable than surgery 

  • Short or long-term option

  • Reduce heaviness and pressure

  • Allow autonomy over when to use the pessary ie. all day or specific tasks 

 

Who may not be a candidate?

Most women are suitable. You may not be suitable if you have any of the following: 

  • Active vaginal infection or poor vaginal tissue health

  • Inability to attend follow up

  • Cognitive impairments without support

  • Limited dexterity

  • Known allergy to silicone 

  • Vaginal or cervical cancer, or previous pelvic radiotherapy 

  • Undiagnosed vaginal bleeding 

  • Inability to comply with self-management and follow-up requirements

Risks and complications 

Common side effects of pessary use :

  • Increased vaginal discharge

  • Light bleeding/spotting

  • Vaginal irritation

  • Vaginal infection

  • Masked incontinence.

Less common but more serious complications

  • Difficulty emptying the bladder or bowel

  • Pessary being embedded 

  • Vaginal tissue abrasion or ulceration

  • The biggest risk is when a pessary is neglected, which can cause sepsis, fistulas or death

 

You physiotherapist will go through a management plan should complications occur

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What does self-management and the fitting process involve? 

Shared care 

  • Your physiotherapist will recommend an appointment with your doctor before fitting a pessary, to ensure other pathologies are excluded 

 

How is a pessary fitted?

  • The physiotherapist will assess your appropriateness for a pessary via questioning and a vaginal examination

  • A ring pessary is often trialed first

  • The physiotherapist will insert it and check how it supports you in different positions, while doing different tasks and ensure your bladder empties well

  • Different pessary shapes or size may be tried to optimise fit and support and it is possible it may take multiple attempts of pessary sizes and shapes, as each vagina and anatomy is different. This may take more than one appointment. It is also possible no pessary will help manage your symptoms.

  • You will be taught how to insert, remove and look after your pessary and your tissue. This is called self-management.

 

What appointments do I need? 

  • Attend a 1-week telehealth review

  • Attend a 4–6 week face-to-face review

  • A period of 4 months of conservative treatment is recommended before measuring treatment effectiveness 

  • Touch base with the clinic in 12-months, which is when your pessary will need to be replaced and you will need to re-do your GP screen

  • You can always reach out earlier if needed

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