Pessaries
Hi, Bestie! Today, we’re talking about pessaries! What’s a pessary? That’s certainly important information to know before we dive into this topic. A pessary is a rigid, prosthetic device that is inserted into the vagina for a variety of medical purposes. It can be used to treat stress urinary incontinence (SUI), pelvic organ prolapse (POP), and more. Let’s talk about it!
What are pessaries used for?
Pessaries have a wide range of functions and are used for many gynecological problems. They usually fall into the following categories: support pessaries and space-filling pessaries (1). Note that vaginal suppositories, which are used to deliver medications locally to the vaginal tissue, are sometimes called pharmaceutical pessaries. These are a completely different breed of pessary and we won’t be going into detail about these in today’s chat. Okay, back to business! A support pessary will elevate the prolapsed tissue (1). These are usually used for more mild cases of prolapse or SUI. A space-filling pessary works by filling the space of the upper vagina in order to stop the pelvic organs from pushing into the vagina (1). This type of pessary is usually used in more advanced cases of prolapse.
Pessaries are commonly used in the management of POP (1). While POP it is typically not painful, it can be uncomfortable and irritating. Folks with POP often talk about a feeling of pressure in the vagina or pelvis and in some cases, POP can lead to urinary and bowel issues such as difficulty with complete emptying of the bladder or bowel (2). A pessary can help to support the organs of the pelvis and alleviate uncomfortable pressure. It can also help reposition the bladder to aid in complete bladder/bowel emptying (2,3).
A pessary can also be used to manage SUI (4). As we’ve discussed previously, SUI can occur when the urethra is hypermobile or when the pelvic floor isn’t strong enough to provide pressure to the urethra to stop urine from leaking out. A dish pessary or ring pessary with a knob can be used to provide extra support to the urethra in order to manage SUI.
Types of pessaries:
Pessaries come in a variety of shapes and sizes. Common shapes include the ring with support, the ring with knob (with or without support), the cube, the Gellhorn, and the dish. Different pessary shapes lend to different functions. For example, the ring with knob pessary are best for SUI as the knob provides compression to the urethra, helping to reduce urinary leakage. The cube pessary is designed for uterine prolapse and prevents downward descent of the uterus. Ring pessaries are more commonly used for prolapse of the bladder and/or rectum.
Pessary Fitting:
Pessaries are made out of soft, but firm silicone or plastic. They are meant to be supportive while still being easy to remove and replace. Each person has their own unique anatomy, so pessaries are not a “one-size-fits-all” device. Your pessary will need to be fitted by your medical provider. Physical therapists that are trained in pessary fitting can fit your pessary for you. However, it is more likely that you will get this done at your gynecologist’s office, either by your OB-GYN or a specialty-trained nurse. Note that it might take a few tries before finding the correct fit. While it shouldn’t be painful, some patients have described the experience of getting a pessary fit as uncomfortable. Once you have your correctly-fitting pessary, you should be able to wear it comfortably and without issue. If it is in the right spot, you should be able to do all of your regular activities, including penetrative intercourse, without removing your pessary. It is essential that the pessary fits appropriately in order for it to function well, but more importantly, for maximal comfort. If your pessary is uncomfortable, you are less likely to use it as a management tool long-term.
Pessary care:
Pessaries are appropriate treatment/management tools for both short-term and long-term use. Some folks will elect to use a pessary in the short-term to alleviate symptoms of POP while working on pelvic floor muscle (PFM) strengthening (5). After achieving increased PFM strength, they might notice POP symptoms have decreased and they have no need for the pessary. Others will need to use their pessary long-term. For example, in someone with severe prolapse who either doesn’t want to or is not a candidate to undergo surgical repair, a pessary is a viable long-term management option.
Whether used in the short- or long-term, pessary management is key. The pessary should be removed and cleaned regularly. Talk with your provider about how often you should remove and clean your pessary. If you are capable, you may remove your pessary every week. Your pelvic health physical therapist will be able to help you with learning how to remove and insert your pessary (6). They can be difficult to bend and very slippery, so having someone to guide you through your first few attempts can make a big difference. If you are still having trouble removing your pessary, you might have more success with a pessary hook. The pessary hook is a device with a hook on one end and a fork on the other end. The fork end can help with pessary insertion and the hook can help with removal. Use of this device also takes a bit of practice, so give it a few tries and don’t worry if you don’t get it right away! Be sure to wash your hands before removing or inserting your pessary. It might help to put a bit of lubricant on the pessary before you insert it to help with the insertion process.
Some folks are unable to remove and/or insert the pessary themselves. This could be due to a variety of reasons such as arthritis, poor mobility and more. These people will need to visit their medical provider to have their pessary removed. In these cases, pessaries may remain in place for up to six months.
If you have POP or SUI, ask your provider about pessaries and whether they would be a possible treatment option for you. They’re not for everyone, but they work incredibly well for some. You got this!
XOXO,
Your Pelvic Bestie
References:
1. Irion JM Irion G. Women’s Health in Physical Therapy. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.
2. Lamers BH, Broekman BM, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Int Urogynecol J. 2011; 22: 637-644.
3. Brazell HD, Patel M, O’Sullivan DM, et al. The impact of pessary use on bowel symptoms: one-year outcomes. Female Pelvic Med Reconstr Surg . 2014; 20: 95-98.
4. Al-Shaikh G, Syed S, Osman S, Bogis A, Al-Badr A. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. Int J Womens Health. 2018 Apr 17;10:195-201. doi: 10.2147/IJWH.S152616. PMID: 29713205; PMCID: PMC5909791.
5. Nemeth Z, Ott J. Complete recovery of severe postpartum genital prolapse after conservative treatment: a case report. Int Urogynecol J. 2011; 22: 1467-1469.
6. Grimes CL, Balk EM, Crisp CC, Antosh DD, Murphy M, Halder GE, Jeppson PC, LeBrun EE, Raman S, Kim-Fine S, Iglesia C. A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence. International Urogynecology Journal. 2020 Apr 27:1.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
