Pessaries
What is a pessary?
A pessary is a silicone device (usually in the shape of a ring or a cube) used inside the vagina to support pelvic organ prolapse via the vaginal walls.
Ring pessary supporting the vaginal walls.
It is an additional management approach to prolapse alongside pelvic floor muscle training, lifestyle advice and hypopressives. It is particularly useful for women who find the symptoms of prolapse like vaginal heaviness bothersome day to day. It can also be used as a vaginal support (similar to a sports bra) for women who want to carry on with exercise like running or cardio without vaginal symptoms or urinary leaking.
How do i know if i need a pessary?
Your Physiotherapist will listen to you and how you are feeling, what symptoms you are experiencing and what your goals are. We will then assess your vaginal walls in lying and standing to ascertain if there is signs of prolapse. We also check your pelvic floor muscle function. We can also tell by this assessment what shape and size pessary would be suitable. Lastly, we may want to take a look at the vaginal walls for any signs of dryness/redness which may make using a pessary uncomfortable for you.
What happens then?
If there is some redness in the vagina, we may ask you to use some vaginal oestrogen cream (via GP prescription) for a few weeks to improve the vaginal walls prior to fitting a pessary.
There can be some trial and error involved in getting the right size and fit for you. A good fit is when it feels supportive and there is no rubbing, discomfort and the pessary does not fall out! so we may need to bring you back once or twice to try a different size etc.
We also teach you to self-manage your pessary, In other words, you will practice putting it in and out of your own vagina in clinic, so you are happy with the technique. This is much better as you can use it whenever you want and take it out for a rest (for example at night time, if you wish) and for any reason if it doesn`t feel right inside, you can take it out yourself without having to wait for a clinic appointment.
Follow up Care
We write to your GP or Gynae to let them know we have fit a self-managing pessary. We have a follow up appointment in clinic,after 6 weeks to see how you are getting on with your pessary and check the vaginal walls again. After that a review every 6 months is advised for on-going care if you continue to use your pessary.
If you are interested in the use of vaginal pessaries for prolapse or not sure if prolapse is the main cause of your symptoms, then we advise booking an initial women`s health appointment to get the ball rolling!
