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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.  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 just with exercise​

Pessary self management

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01

Shared medical care

Your physiotherapist will recommend an appointment with your doctor before fitting a pessary, to ensure your mucosa can tolerate it and other pathologies are excluded 

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What appointments do i need?

  • FItting appointment, $300 including the appointment fee and the pessary

  • Attend a 1-week telehealth review

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

  • A period of 4 months of treatment is recommended before assessing its 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

02

The fitting process

  • 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.

  • Fittings 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. 

Risks and complications 

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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​

Who may not be a candidate?

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

  • Active vaginal infection

  • Poor vaginal tissue health

  • Inability to attend follow up and comply with regular reviews

  • Cognitive impairments without support

  • Known allergy to silicone 

  • Vaginal or cervical cancer

  • Previous pelvic radiotherapy 

  • Undiagnosed vaginal bleeding 

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