Pessaries – what are they, when to use them and what are their benefits?
Pessaries are becoming more commonly used by women to primarily control symptoms of pelvic organ prolapse (POP) but can also be used to help manage stress urinary incontinence (SUI) and can be a very effective alternative to surgery. They can be used on an ‘as needed basis’ or can be worn on a more continuous basis depending on the needs of the wearer. But what are they exactly, how do you know if they are right for you, and what does using one look like?
What is a pessary?
A pessary is a medical grade silicone device that is inserted into the vagina to support either a prolapsing organ, or in the case of stress urinary incontinence, the urethra. They come in a variety of different shapes and sizes that are designed to support the specific needs of the wearer. Pessary use is increasing due to increased awareness of their benefits by both medical professionals and users, together with more research on the use and benefits of pessaries and as a result, more variety in types of pessaries available.
What conditions can a pessary be used for and is it right for me?
The most common reason for using a pessary is pelvic organ prolapse. Types of prolapse can include anterior wall prolapse (often involving the bladder), posterior wall prolapse (often involving the rectum), or apical prolapse (either involving the uterus/cervix or the vaginal vault if you have had a hysterectomy). A pessary can also be used for managing stress urinary incontinence. A pessary may be recommended as an alternative to surgery or to help manage symptoms prior to or while waiting for surgery.
Symptoms of prolapse more commonly include a sensation of bulging, pressure or falling, either internally or externally to the vagina that are more bothersome and uncomfortable than painful. However, with more advanced prolapse, there can sometimes be associated lower back or pelvic girdle pain. Prolapse is graded from a stage 1-4 with a stage 1 being the most minimal (often non-symptomatic) to a stage 4 which is when the prolapse extends beyond 2cm below the vaginal opening.
Diagnosis of a pelvic organ prolapse is most commonly done by your family doctor, gynaecologist or a pelvic floor physiotherapist specializing in the assessment and treatment of pelvic organ prolapse. Depending on the stage of your prolapse, it may be recommended for you to start with a pelvic floor muscle training program to provide better support for the pelvic organs. If this recommended treatment is unsuccessful or if the prolapse advances or falls below the level of the pelvic floor muscles, a pessary may be recommended. Using a pessary can help you to avoid or delay the need for surgery.
Pessaries have come a long way over recent years and come in a variety of shapes and sizes to provide more specific support for the varying types of prolapse. They can be completely self-managed by the wearer and can be worn on a continuous basis i.e. throughout the day, or on an ‘as needed basis’. This might involve wearing the pessary only for short periods with more provocative activities such as running, hiking, lifting or longer periods on your feet. Some pessaries can be inserted and left for several days/weeks without needing to be removed, while others will need to be taken out overnight. The type of pessary you use will depend on your type of prolapse and what pessary best resolves your symptoms during your pessary fitting appointment.
What steps do I take if I want to use a pessary?
A pessary fitting can be done by some family physicians, a gynaecologists or a pelvic floor physiotherapist specialising in pessary fitting (Hannah Barnes at Trillium Integrative Health Centre). You will first need to be assessed as to whether a pessary would be an appropriate treatment strategy for you. Your medical provider will then discuss the option of a pessary, whether this is something you would like to try and whether you are comfortable with managing the insertion and removal of the pessary, together with the cleaning care of the pessary. If you decide you want to go ahead with the option of a pessary, you will then be scheduled for a pessary fitting. Once starting use of a pessary, you will then need to follow-up with your healthcare provider at prescribed intervals to ensure that your symptoms are being properly managed and that the pessary is well tolerated. Pessaries should not cause discomfort or pain. If this is the case, it must be communicated with your healthcare provider. Overall, pessaries are an excellent option for a lot of women and are usually easy to self-manage and care for while resolving a lot of the bothersome symptoms that can come with pelvic organ prolapse.
If you are wondering whether a pessary is the right option for you, or if you have more questions, please talk to your family physician or book an Initial Pelvic Floor Assessment with our pelvic floor physiotherapist Hannah Barnes who specializes in the fitting of pessaries.