Many women are aware of the potential benefit of pelvic floor exercises for bladder leakage and prolapse symptoms. But there’s an often little-known, low-risk device that can cause great improvement, if not immediate relief, for many pelvic floor problems. Enter: the vaginal support pessary.
What’s a pessary and why haven’t I heard of this before?
Vaginal support pessaries are small devices, often made of medical-grade silicone, that are specially designed to be fitted in the vagina either long- or short-term for a variety of pelvic floor symptoms. Historically they were used only by gynaecologists for elderly women who were unsuitable for surgical intervention due to safety concerns. Nowadays, pessaries can be fitted by a variety of suitably-trained health professionals including GPs, nurses, and pelvic health physios (that’s us!).
Unfortunately, there still seems to be a hang-up around offering women the option to try a pessary early on in their symptom journey (or even prophylactically if you’re at a high risk of developing a prolapse postpartum), which may explain why it’s never been offered to you before.
How can I get fitted for a pessary through Pelvic Fix Physiotherapy?
If you are deemed suitable to trial a pessary (there are certain situations in which it is NOT appropriate to use a pessary yet, including things like infection, abnormal bleeding, significant atrophy (thinning of the vaginal tissues), high-risk pregnancies, early postnatal/post-op, or after having surgery involving vaginal mesh), we first use our sterilisable “fitting kit” pessaries to see if they will work for you. On average, women need to try 2-3 different types/sizes of pessary to find the right fit, so don’t panic if the first few goes aren’t a huge success – this is common!
Once we find the correct fit, you give it a little test drive with some provocative activities - like a cough, squat or jump - and get coaching on how to get the pessary in and out (don’t worry, it’s not much trickier than a tampon or menstrual cup!). Once you’re feeling happy and confident – voila! You purchase your own single-use pessary to take home with you!
How often do I need my pessary reviewed?
Once you have your own pessary, we catch up a couple of weeks later to make sure everything is going well and the pessary is staying in place and doing its job. If all is well, we catch up again around 3-4 months later, then every 12 months for a pessary replacement (they tend to degrade over time with regular use). With your permission, we write a letter to your GP to let them know what type of pessary you’re using, and to encourage you to visit them for an annual speculum examination (we don’t use speculums in our clinic) to ensure the pessary isn't causing any pressure issues.
This plan is suitable if you are self-managing your pessary (i.e. you are able to take it out and clean it regularly, usually every 1-7 days depending on the type). Some women are not able to self-manage their pessary (due to issues like arthritic hands or mobility limitations). Instead they may choose to have their pessary use overseen by a gynaecologist, who will fit a new pessary for you every 3-6 months and which stays in the whole time.
Are there any negatives to using a pessary?
There are very few reasons not to give a pessary a try, and the risks are quite low if you self-manage your pessary (i.e. take it out regularly, give it a clean, and have an overnight break). The side effects can be discomfort or difficulty emptying the bladder or bowel (commonly if the pessary fitted is too large); increased discharge; infection; and bleeding. Some of these side effects can be mitigated with the use of vaginal oestrogen supplementation, particularly for perimenopausal women whose natural hormones are low.
How do I find out more?
During your initial consultation with either Mischa, Monique or Sophie, most women who present with prolapse +/- stress incontinence will receive information on different management options for their symptoms, including a pessary trial. If this is something you wish to know more about we can certainly speak about this in detail during our sessions, which you can book online here. (If you are already sure you would like to try a pessary, or are already using a pessary but would like to speak about other pessary options, please book your appointment with Mischa.) You can also speak to your GP or OBGYN about using a pessary.
In summary: we LOVE pessaries and find them to be a really great treatment option for women of all ages and stages who are (a) medically suitable and (b) actively interested in trying one. In our opinion, they are a low-risk and low cost first option for women symptomatic of prolapse or stress incontinence when compared with invasive surgical interventions (with no recovery time required!). They are a great supplement to pelvic floor muscle training and lifestyle modifications to keep women active and comfortable, doing the things they love to do!
Get in touch today to find out if a pessary will be suitable for helping YOU achieve relief from your pelvic floor symptoms. We can't wait to work with you x