What Is a Pessary Used For?
If you have been told you might benefit from a pessary, you may be wondering what a pessary is used for. A pessary is a vaginal support device that helps support the pelvic organs and reduce symptoms related to pelvic floor dysfunction. It is a non surgical option that can be used short term, long term, or only during certain activities depending on your symptoms.
What Is a Pessary?
A pessary is a vaginal support device used to treat pelvic organ prolapse and stress urinary incontinence. It is a soft silicone device that is typically inserted vaginally by either the user or a healthcare provider.
A pessary is like a sports bra for the pelvic organs. It provides support and helps hold structures in place. Pessaries are sized and fitted to the person using them, and there are different types just like there are different types of bras. Everyone has a preference, and certain shapes work better for different diagnoses.
Some of the more common shapes of pessaries include a cube, a ring, a ring with a knob, and a gelhorn. There are also dish and donut pessaries. The type used depends on symptoms, anatomy, and comfort.
A pessary is an excellent non surgical option for treating pelvic organ prolapse. It is generally recommended more for stage 1 through 3 pelvic organ prolapse, though I have personally fitted a stage 4 prolapse and the woman using it had success and avoided surgery.
For patients who are symptomatic all the time, I typically recommend inserting the pessary in the morning and removing it at night. It can then be cleaned at night in a sterilizer before being reinserted the next day.
Some patients are only symptomatic during certain times of their cycle or with certain activities. In those cases, I may recommend inserting the pessary only for those specific activities.
Using a pessary does require a good amount of dexterity to insert and remove correctly. When this is not possible, the pessary can be provider managed. These patients see a medical provider who removes, sterilizes, and reinserts the pessary at scheduled visits.
Common Conditions a Pessary Is Used For
A pessary is used for several pelvic floor conditions. One of the most common is pelvic organ prolapse, which is where descent of one or more of the pelvic organs falls into the vaginal canal.
A bladder prolapse is called a cystocele. This is where the bladder falls into the vaginal canal. A uterine prolapse is where the uterus falls from above and slackens the vaginal walls. This will often also lead to bladder or rectal prolapse.
A rectocele is where the rectum falls into the vaginal wall and into the vaginal canal.
Pessaries are also used for urinary incontinence, which is bladder leakage. There are two types of urinary incontinence. Stress urinary incontinence is leakage with laughing, jumping, coughing, sneezing, running, or anything high impact on the pelvic floor. Urge urinary incontinence is leakage with things like hearing running water or walking to the bathroom. A pessary does not treat urge urinary incontinence, but it can help treat stress urinary incontinence.
When stress urinary incontinence is not fully treated by pelvic floor therapy alone, it is often because the urethra is hypermobile. The urethra is the tube that carries urine from the bladder to outside of the body. When it is too mobile, it needs additional support to maintain continence.
When a pessary is inserted, depending on the type used, it sits on the pelvic floor behind the bladder. This is often a ring pessary. It provides additional stability so the urethra cannot move excessively, which helps reduce leakage.
Pessaries are also an underutilized tool for postpartum pelvic organ support and rehab. They can provide additional support to the pelvic floor during recovery.
A pessary can also be used to avoid or delay surgery. Some patients use a pessary only during certain activities or during certain times of their cycle when symptoms are worse.
The Pessary Fitting and Sizing Process
You can be fitted and sized for a pessary by a medical doctor or a pelvic floor physical therapist. There is specific training that has to be completed for pelvic floor therapists to be credentialed to perform this process, so it is important to ask about this when scheduling.
The fitting is an internal assessment performed digitally to size and fit the pessary. It should not be painful, but it can be uncomfortable for someone who already has pelvic pain.
Some people are able to walk away with a pessary the same day. This depends on whether the practice has pessaries in stock. If not, the pessary may need to be ordered and you will return for a follow up appointment after the initial sizing assessment.
The best pessary shape should be selected based on symptoms or type of prolapse. The sizing is then based on the vaginal canal.
At my office, I like to have patients insert the pessary, urinate with it in place, and then learn how to remove and reinsert it on their own. I also have patients perform exercises to make sure the pessary stays in during movement and is not bothersome.
This is a major benefit of pelvic floor physical therapists performing pessary fittings. There is typically more time available during the appointment to practice inserting, removing, exercising, and urinating with the pessary rather than simply placing it and sending you home.
If patients are removing the pessary daily, I typically recommend using a sterilizer designed for menstrual cups or discs. I recommend removing it at night, placing it in the sterilizer while sleeping, and reinserting it in the morning.
Sometimes there is a process of trial and error to find the right size. If the first pessary does not fit well, adjustments may be needed. This is especially common with prolapse, since prolapse can vary throughout the day based on gravity and activity.
We would love to help..
If you experience urinary leakage or have prolapse and are wanting a pessary for yourself, good news! We are currently accepting patients in person in Rockwall, Canton, and Sulphur Springs.
If this is something you are experiencing, we would truly love to help support you it.
You can reach out to us here and we will follow up with a phone call to get you scheduled, or you can call the office at 903-962-2600.
