You may have heard the term vaginal pessary, but what exactly are they, and what do they do? Tus discusses these little devices which are often described by patients as “life changing”, in more detail.
What is a vaginal pessary?
A vaginal pessary is a silicone support device which sits within the vaginal canal to provide upward support for the pelvic organs (the bladder, uterus, or bowel) or the urethra.
Pessaries come in many different shapes and sizes, and while they can look quite daunting, when they are inserted and fitted correctly, you should not feel anything when you are wearing one. While their shapes may also look odd, they are designed specifically to provide different levels of support for different organs. As well as this, the silicone material they are made out of allows them to be quite flexible, making them easier to insert and remove.
The style, shape and size of the pessary is customised to fit your pelvic floor and will vary depending on your symptoms, or your pessary’s purpose.
When would you use a pessary?
Pelvic organ prolapse
For those who experience symptoms of pelvic organ prolapse (such as vaginal heaviness or dragging) a pessary can be a great option to both alleviate symptoms and provide upward support for the organs. Anyone who is trying to avoid surgery for pelvic organ prolapse may also benefit from trial of a pessary use as an option for conservative management.
Stress urinary incontinence
Stress urinary incontinence is leaking of urine when you cough, sneeze, laugh, jog or run. While pelvic floor exercises can sometimes help, in other cases it can be extra movement or mobility of the urethra that is causing the leaking. There are a variety of different pessaries designed specifically for stress urinary incontinence to address leaking due to extra movement in the urethra, by providing support behind the urethra.
Preventatively
Pessaries can also be used preventatively. If you have given birth and would like to return to high impact exercise such as jogging, skipping, or lifting heavy weights, a pessary is a great way to do this. While postnatal, the support structures to the pelvic organs (the fascia and pelvic floor) might still be quite lax and allow extra downward pressure on the pelvic floor putting the pelvic floor at risk during high impact exercise. A pessary is a great way to provide upward counter-support for your pelvic organs while you engage in high intensity exercise. For preventative use, a pessary might only need to be used during exercise.
What are possible side effects?
There can be risks of vaginal wall irritation and if poorly managed, possible vaginal wall erosions, which is why good pessary care and regular follow up appointments are important (and why we will also ask you to review with your GP for a speculum check). While discharge levels usually increase with pessary wear, if your discharge becomes green or yellow looking, there can be a risk of bacterial vaginosis. In some cases, pessary use can uncover hidden stress urinary incontinence symptoms, but this can be managed by changing the style of the pessary. Pessaries can be used during pregnancy, but have higher risks, and require written consent from your obstetrician or midwife. If you have had pelvic surgeries involving mesh or tapes, this may limit the type of pessaries that are suitable.
At the beginning of your pessary fitting, your physiotherapist will discuss and all possible risks, and any concerns you may have.
How do you look after and care for a pessary?
Our physios will help you find your individual best fit for your pessary. We will also teach you how to insert, remove and care for your pessary. After this, you will take it home and try it for a week and then return for a follow up appointment. Pessaries may require a few follow up appointments, as it can take some testing to find you the best fit. After this we review you in a month, then six and twelve months.
Some women may require vaginal oestrogen cream prior to, and during use of their pessaries. Different styles of pessaries can stay in for different lengths of time. Some pessaries may be left in for intercourse, while others may need to be removed.
Pessaries are often described as ‘life changing’ for many patients, allowing them to go about their day to day activities or exercise symptom free, knowing their pelvic organs are supported and safe. While pessaries at first may seem a bit tricky, our physiotherapists have had many years experience in fitting pessaries, and are here to help you find your best fit, and confidence in your pelvic health.
If you have any questions, or would like to book in for a pessary fitting, please contact our clinic for more information.
Written by Tusanee Jierasak
