Understanding Pessaries for Pelvic Prolapse

Pelvic Organ Prolapse (POP) is a condition that affects millions of people, primarily women, often leading to discomfort, frustration, and emotional distress. It occurs when one or more of the pelvic organs—such as the bladder, uterus, or rectum—drop from their normal position and protrude into the vaginal canal. This can lead to a variety of symptoms, including pelvic pressure, urinary incontinence, bowel issues, and sexual dysfunction. While surgical treatments are commonly offered to manage POP, many individuals seek non-invasive solutions. One such option is the use of a pessary. We are help improve understanding pessaries for pelvic organ prolapse.

A pessary is a medical device that can help manage the symptoms of pelvic organ prolapse without the need for surgery. In this blog post, we’ll explore what a pessary is, how it works, who might benefit from using one, and its advantages and limitations.

What is a Pessary for Pelvic Organ Prolapse?

A pessary is a flexible, usually silicone or rubber device, designed to be inserted into the vagina to support the pelvic organs. It essentially works by physically lifting and holding the organs in place, helping to alleviate the symptoms associated with pelvic organ prolapse. Pessaries come in various shapes and sizes, with some resembling a ring, while others are more like a cube or a donut. A healthcare provider will determine the type and size of pessary that best fits the individual’s anatomy and the severity of their prolapse.

https://www.pelvicorganprolapsesupport.org/pessary-info

How Does a Pessary Work?

A pessary works by providing mechanical support to the pelvic organs. In the case of pelvic organ prolapse, the pelvic floor muscles, which normally support the pelvic organs, are weakened or stretched. This can happen due to pregnancy and childbirth, aging, obesity, or other factors. When the pelvic floor muscles are compromised, the organs can start to descend, leading to prolapse.

The pessary is inserted into the vaginal canal and placed at the base of the pelvic organs. Once in place, it helps hold the organs up, preventing them from prolapsing further. The pessary essentially "buys time" for the individual by relieving symptoms such as pelvic pressure, urinary incontinence, and discomfort. It is a non-invasive, reversible, and adjustable option that can help people manage their prolapse symptoms without resorting to surgery.

Who Can Benefit from a Pessary?

Pessaries are often recommended for people with mild to moderate pelvic organ prolapse who either are not candidates for surgery or prefer non-surgical options. Some people may use a pessary as a temporary solution while they consider their surgical options, while others may use it long-term as an effective management tool for their prolapse.

Those who are good candidates for pessaries include:

Women who are not ready for surgery: Pessaries are an ideal choice for individuals who are looking for a non-invasive option. Surgery, though effective, can involve recovery time and risks, which may not be appropriate for everyone.

People with mild to moderate prolapse: If prolapse is not severe, a pessary can be highly effective at alleviating symptoms. For more advanced cases, surgery may still be required, but a pessary can provide relief in the interim.

Postpartum women: Some women who have recently given birth may experience temporary prolapse due to the stretching of the pelvic floor. Pessaries can help relieve symptoms during this time as the body heals and strengthens.

People who are not candidates for surgery: Some individuals, due to age, comorbidities, or other health concerns, may not be eligible for surgery. Pessaries can offer an alternative solution in these cases.

Women who wish to maintain their fertility: For women who still want to have children, using a pessary allows them to manage the prolapse symptoms without impacting their fertility or the option for future pregnancy.

Types of Pessaries

There are many different types of pessaries, and the choice depends on the specific needs and anatomy of the individual. Here are some of the most commonly used pessaries:

Ring Pessary: This is one of the most commonly used types. It’s shaped like a circular ring and is effective for supporting the bladder and uterus. It works well for mild prolapse and is comfortable for many users.

Gellhorn Pessary: This type has a disk-like shape with a stem. It is typically used for more advanced prolapse or when a ring pessary is not effective. It provides more support and is usually preferred for rectocele (rectal prolapse).

Cube Pessary: Shaped like a small cube, this pessary is often used for more severe cases of prolapse. It helps support the vaginal wall, especially when the prolapse affects multiple pelvic organs.

Donut Pessary: As the name suggests, this pessary is shaped like a donut and is often used for moderate prolapse. It offers more support than a ring pessary but is more comfortable for some women compared to other types.

Hodge Pessary: This type has an L-shaped design and is often used in cases where the prolapse is not symmetrical. It helps with both vaginal and rectal prolapse.

Benefits of Using a Pessary

Pessaries offer a variety of benefits for people with pelvic organ prolapse, including:

Non-invasive: Unlike surgery, pessaries don’t require incisions or a lengthy recovery process. They provide an effective way to manage prolapse without the risks associated with surgery.

Customizable: Pessaries come in various shapes, sizes, and materials, meaning that they can be tailored to the individual’s needs. A healthcare provider will work with the patient to find the best fit.

Immediate symptom relief: For many people, a pessary offers immediate relief from the uncomfortable symptoms of pelvic organ prolapse, including pelvic pressure, urinary incontinence, and vaginal bulging.

Non-permanent: Pessaries are removable, meaning that they don’t have any long-term effects on the body. If the pessary becomes uncomfortable or doesn’t fit well, it can be removed or replaced with a different size or type.

Safe for women who want to maintain fertility: Pessaries can be used by women who wish to avoid surgery while preserving their ability to conceive in the future.

Cost-effective: For those who want to manage prolapse symptoms without undergoing surgery, using a pessary is often a more affordable option.

Limitations of Pessaries

While pessaries can provide relief for many individuals, they are not without their limitations:

Discomfort: Some people may experience discomfort or irritation, especially if the pessary is not fitted correctly. This can include vaginal irritation, difficulty inserting or removing the device, or pressure-related pain. If you are menopausal or breastfeeding, your estrogen levels can be lower causing decreased vaginal tissue quality and therefore increased likelihood of discomfort. Your healthcare provider may discuss vaginal estrogen cream as an option to reduce the risk of discomfort. 

Frequent adjustments: Pessaries may need to be adjusted periodically, and in some cases, they need to be replaced over time. This can require regular visits to a healthcare provider.

Not a permanent solution: While pessaries can provide long-term relief, they do not address the underlying issue of pelvic floor weakness. In some cases, surgery might still be necessary to correct the prolapse permanently.

Not suitable for all types of prolapse: Pessaries are most effective for mild to moderate prolapse and may not be as effective for advanced prolapse cases or those with multiple organs affected.

Conclusion

Pessaries are a valuable non-surgical option for individuals with pelvic organ prolapse, offering symptom relief and improving quality of life. They provide an effective way to manage prolapse for many people, especially those who are not ready for surgery or are not candidates for surgery. However, it is essential to consult with a healthcare provider to determine if a pessary is the right option and to ensure proper fitting and care. Many pelvic floor physical therapists, including those here at Renew PT, are trained in pessary fittings and care.

For those living with pelvic organ prolapse, a pessary may provide the support needed to maintain daily activities and well-being. It’s essential to remember that while a pessary is a highly effective solution for many, it is just one tool in managing the condition. Talking to a healthcare provider, including your pelvic floor physical therapist, about the best approach for managing prolapse is key to achieving the best outcome.