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Using a Pessary for Symptoms of Prolapse

By Kirrily Curran (Women's Health Physiotherapist, physiozest)

About 1/3 of women will experience some degree of prolapse in their lifetime.

A prolapse is the name used when an organ in your pelvis (your uterus, bladder, rectum or bowel) moves downward into the vaginal hiatus instead of sitting higher, in their normal position. This can cause feelings of heaviness, bulging or dragging in the vagina and incomplete emptying of your bladder or bowel.

The descent of pelvic organs can result from over-stretched or damaged ligaments, connective tissue and/or pelvic floor muscles.

What is a pessary?

A pessary is a small silicone device inserted into the vagina to help support its internal structure. A pessary can be effective in managing symptoms of prolapse.

A pessary may be a long term treatment option or can be a temporary therapeutic option whilst awaiting surgery or performing rehab.

Do I need to use the pessary at all times?

This is dependent on your diagnosis and the reason for needing a pessary. For some people a pessary may only be required when performing exercise or heavy tasks, others may require it for everyday use.

In an ideal situation you may remove your pessary daily and clean it with soap and water. However, this is not always possible, and may need to be managed by your health care provider.

Is a pessary painful?

A properly fitted pessary should not cause pain or discomfort. You should be able to perform all daily activities without difficulty including exercise, coughing/ sneezing and emptying your bladder and bowel.

A pessary that is too small may fall out, and a pessary that is too big may be uncomfortable.

Are there different kinds of pessaries?

Pessaries are soft and flexible and come in varied shapes and sizes. It is important to get professionally fitted for your pessary and it may take a few tries to get the correct size and shape for you. The type and size will depend on your symptoms and the type of prolapse.

The most common types of pessary include:

Ring pessary:

· bladder prolapse (cystocele)

· mild to moderate uterine prolapse.

· Rectocele

· enterocele

Cube pessary:

· more severe grades of uterine prolapse

· mild cystocele

· mild rectocele

· vaginal vault prolapse

Ring with Knob/ support:

· cystocele with stress urinary incontinence

· mild uterine prolapse

Other less common pessaries include the Gellhorn, Gehrung, donut and inflatable.

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