Pessary for Prolapse Treatment

A pessary is a removable device inserted into the vagina to provide support for pelvic organs affected by prolapse. This non-surgical option can effectively manage symptoms and improve quality of life for many women experiencing pelvic organ prolapse.

What is a Pessary?

A pessary is a prosthetic device made of silicone or similar flexible material. It comes in various shapes and sizes to accommodate different types and severities of prolapse, as well as individual anatomy.

Did you know?

Pessaries have been used for centuries to manage prolapse, with modern versions offering improved comfort and effectiveness.

How Does a Pessary Work?

A pessary works by:

Providing physical support to prolapsed organs
Helping to keep pelvic organs in their proper position
Alleviating pressure on the pelvic floor
Reducing or eliminating symptoms associated with prolapse

Types of Pessaries

There are many types of pessaries, including:

Ring pessaries
Gellhorn pessaries
Cube pessaries
Donut pessaries
Inflatable pessaries

Your urogynecologist will help determine which type is best suited for your specific needs.

Benefits of Using a Pessary

Non-surgical option for prolapse management
Can be used long-term or as a temporary measure
Allows for continued sexual activity (with most types)
Can be easily removed and reinserted
May help determine if surgery would be beneficial

The Fitting Process

Getting the right fit is crucial for comfort and effectiveness. Here’s what to expect:

Your doctor will assess your prolapse type and severity
They’ll select an appropriate pessary type and size
The pessary will be inserted and you’ll be asked to walk around, sit, and stand
You’ll provide feedback on comfort and fit
Adjustments will be made as necessary

It may take a few tries to find the perfect fit, so patience is key. In general, we’re able to successfully fit 90% of patients with a pessary and 50% are still wearing them a year later.

Living with a Pessary

Once fitted with a pessary:

You’ll learn how to insert and remove it yourself (if desired)
Regular check-ups will be scheduled to ensure proper fit and assess vaginal health
You may need to remove it periodically for cleaning (frequency varies by type)
Some women wear pessaries continuously, while others remove them at night

What Does It Feel Like?

A properly fitted pessary should be comfortable and barely noticeable in your daily life. As Dr. Stewart often explains:

“A good-fitting pessary wears like a pair of glasses or a wristwatch. If you think about it, you know it’s there, but you shouldn’t notice it otherwise. It should do its job without any discomfort or irritation.”

If you experience any persistent discomfort or irritation, it’s important to contact your healthcare provider, as this may indicate that an adjustment or re-fitting is needed.

Caring for Your Pessary

Proper care is essential for comfort and hygiene. The care routine for your pessary will depend on its shape, size, and your personal preferences. Dr. Stewart explains:

“How a pessary is cared for depends on the shape, the size, and the patient’s preference. Some pessaries can be managed by the patient (remove and clean weekly) while others are managed by the doctor’s office (remove, examine, and clean approximately every 3 months).”

Your care routine may involve:

Self-management: For some pessaries, you’ll learn to remove, clean, and reinsert the device yourself, typically on a weekly basis.
Office management: Other types may require visits to your healthcare provider approximately every 3 months for removal, examination, and cleaning.

Potential Challenges

While many women use pessaries successfully, some challenges may include:

Initial discomfort as you adjust to the device
Difficulty with insertion or removal
Vaginal discharge or odor
Rare cases of vaginal irritation or ulceration

Most of these issues can be addressed with proper care and follow-up.

Regardless of the type:

Follow your doctor’s specific instructions for cleaning and maintenance
Attend all scheduled follow-up appointments
Report any discomfort or unusual symptoms promptly
Replace your pessary as recommended (usually every 6-12 months)

Your healthcare provider will guide you on the best care routine for your specific pessary and situation.

Is a Pessary Right for You?

A pessary can be an excellent option if:

You prefer a non-surgical approach to prolapse management
You’re not a candidate for surgery or wish to delay it
You’re planning future pregnancies
You want a reversible treatment option
Your symptoms may not be clearly related to prolapse

Dr. Stewart often recommends a trial of a pessary in cases where the link between symptoms and prolapse is unclear:

“I will often recommend a trial of a pessary to patients who have symptoms that I’m not sure are prolapse related. In other words, it is not wise to undergo a surgery if I don’t have good reason to believe it will improve symptoms. Sometimes a short trial of a pessary, even for a few weeks, is enough to tell what symptom relief (if any) we should expect from surgery.”

This approach can help:

Determine if your symptoms are indeed related to prolapse
Provide insight into the potential benefits of surgical intervention
Guide decision-making about future treatment options
Avoid unnecessary surgery if symptoms are not prolapse-related

A pessary trial can be a valuable diagnostic tool, allowing both you and your doctor to make more informed decisions about your treatment path.

Discuss with your urogynecologist whether a pessary – either for long-term management or as a short trial – is appropriate for your situation.

Next Steps

If you’re interested in trying a pessary:

Schedule a consultation with your urogynecologist
Prepare questions about the fitting process and daily use
Be ready to discuss your lifestyle and treatment goals

Remember, finding the right pessary may take some trial and error, but many women find it to be an effective and comfortable solution for managing prolapse.