Pessary Insertion/removal/change

About Pessary Clinic

What is a Pessary?

A pessary is a silicone device that is placed in the vagina to lift the prolapsed organs – bladder, bowel or womb – up, and take the connective tissue (fascia) off stretch. There are many different shapes and sizes, but the most well known pessary is a ring pessary.

A pessary can be used as an interim measure to take the fascia off stretch and lift the organs up so that pelvic floor muscle training can be more effective. People can use a pessary on a daily basis or just for exercise / long days on their feet. It depends on your symptoms.

Will I need one forever?

It depends!

If you have had a baby within the past 2 years, then you may need a pessary for a few months as part of your rehab program. Many women can wean off the pessary or just use for high impact activities as their symptoms improve.

If you are peri or post-menopausal, or have not had a baby within the past 2 years, it is more likely that you will need to continue using a pessary for long-term management of your prolapse symptoms.

Depending on the type of pessary that is suited to you, you may need to self-manage your pessary or be clinic managed.

• Self-management involves removing the pessary and putting it back in yourself.

• Clinic managed pessary means attending a GP, to remove and change the pessary at least every 6 months.

Pessaries for Urinary Incontinence

Pessaries can be effective at reducing or resolving urinary incontinence too, mainly stress urinary incontinence.

These pessaries work by supporting the back wall of the tube out of the bladder (the urethra) and the bladder neck, to help the bladder and urethra absorb the pressures from cough / sneeze / jump / run better and reduce or even stop the leaking. This can work well to enable you to get back to doing what you love such as exercise classes, running, jiving! They can help you enjoy these things again and take away the fear of an accident happening.

How do I know if a pessary will help me?

• If you have been told you have strong pelvic floor muscles but still have a weak bladder or feel pressure or heaviness in the vulva vaginal region, you will likely benefit from a pessary. 

• You need to have an assessment with a clinician that is experienced in assessing and fitting pessaries to manage prolapse and incontinence. Susan has extensive experience in the assessment and fitting of pessaries, and has taught many other specialist physiotherapists in Ireland, the UK and America how to correctly fit these devices to have life-changing effects on women’s lives.

• Sometimes it can take a few trials of different pessaries to find the right fit for you. 

• A pessary can prevent or delay the need for surgical management of prolapse or incontinence.   They don’t work for everyone but when they do, they are life changing.

Aren't pessaries only for older women?

No, not any more!

Traditionally, pessaries were only used in older post-menopausal women.

However there is growing evidence to show the benefit of using pessaries as part of a physiotherapy rehabilitation program in younger post-natal women to:

• Reduce or get rid of prolapse symptoms

• Stop urinary incontinence

• Enable return to exercise which is high impact such as running and football.

• Facilitate pelvic floor muscle strengthening by lifting the pelvic organ higher so pelvic floor exercises or Kegels are more effective. 

Do the pessaries hurt?

No, the pessaries don’t hurt. 

Once your physiotherapist has found the right type and size of pessary for you, fitting or removing the pessary should not hurt. 

When the pessary is inside, you shouldn’t have any awareness of it there, you should just feel better. You should have relief from the heaviness, pressure, discomfort or leaking you were previously experiencing. 

Is there anything I need to do before having a pessary fitted?

Yes. 

Speculum Examination

Every woman that is fitted with a pessary for prolapse or bladder leaks needs to have a speculum exam done by their GP prior to the pessary trial and fit. This is to make sure the vaginal walls are nice and healthy before fitting the silicone device.

It also ensures your GP is fully aware of the pessary management. 

Local Oestrogen

Any peri or post menopausal woman will benefit from a course of local oestrogen prior to having a pessary fitted.

This ensures that the vaginal tissues are in good condition. It also ensures the pessary is comfortable. When there is a lack of oestrogen in the vulva vagina this can contribute to discomfort or bleeding.

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