Let’s talk Pessary Management of Prolapse…
Because surgery and pelvic floor exercises are not your only options if you have a Prolapse. There is really good evidence that pelvic floor exercises (taught and prescribed by a physiotherapist who can assess you with a vaginal examination) and lifestyle modification (teaching you how to breathe, exercise, poo, lift etc in a way that doesn’t significantly increase pressure) can help. But often something extra is needed to manage symptoms, and that’s where a pessary can come in.
A pessary, you ask? ??♀️ isn’t that a medication tablet you insert inside yourself?
This is a different type of pessary. It’s a support pessary, which acts like a splint to give support to the vaginal walls and prevents a prolapse from descending downwards. As I said, kind of like an ankle brace if you need more support around the ankle ligaments.
Here’s five things to know about pessaries:
1️⃣ One size doesn’t fit all… we have sizing kits and we take your measurements and decide which size/s to trial during an appointment. We get you to test things like coughing, jumping, lifting a weight and emptying your bladder before sending you home with anything.
2️⃣ One shape doesn’t fit all. Not all vaginas are the same, ladies! Two of the most common shapes are a ring and a cube, and they would be chosen for different reasons. For example, a ring can stay in for long periods and you can be sexually active with it in, but a cube is more likely to stay in place with someone with low pelvic floor tone or a pelvic floor injury.
3️⃣ You can choose to have a pessary that you leave in for months at a time and don’t worry about, or you can choose to have a pessary that you take in and out just for those activities (E.g. a gym class, a day with your kids, a run) that make you symptomatic. Pros and cons need to be determined.
4️⃣ What if it does more than just decreases your symptoms of the prolapse? Research is now investigating whether wearing a pessary over a period of time (in particular in the Postnatal period) could actually cause the prolapse to improve. By lifting everything into a better position for a long period, what happens to the tissues compared to if everything is on stretch and descended throughout the day? Watch this space…
5️⃣ Not all doctors and Physios can fit pessaries – do your research and see who can assist you if you want to trial this as an option. And a good physio/doctor should have a team of other Physios/doctors to help manage all aspects of skin health, exercise regime, breathing, movement etc.
At the end of the day, it is a foreign body you’re putting inside you and you need to be carefully chosen as an appropriate candidate. But the risks can be significantly less than surgery, so please – pass on this information to anyone you know who is considering surgical management for vaginal prolapse. Maybe there’s something else to consider first…
There’s a list of physiotherapists on the FitRight website who have post graduate training in Pelvic Health Physiotherapy. Call around to see who fits pessaries, because not everyone does.