Understanding Pessaries: A Comprehensive Guide to Non-Surgical Pelvic Support

What is a pessary ?

A pessary is a medical device designed to support pelvic organs or treat certain gynecological conditions, such as pelvic organ prolapse or urinary incontinence. It is a removable device that is inserted into the vagina to provide structural support to the pelvic organs, including the uterus, bladder, or rectum, when these organs have descended or shifted from their normal positions.

Pessaries come in various shapes, sizes, and materials, and they are fitted individually based on a patient’s specific condition and anatomy. The primary functions of a pessary include:

Pelvic Organ Support: Pessaries are used to help lift and support pelvic organs that have prolapsed (i.e., shifted downward) due to weakened pelvic floor muscles or other anatomical factors. Pelvic organ prolapse can cause symptoms such as pelvic pressure, urinary leakage, and difficulty with bowel movements.
Urinary Incontinence Management: Some types of pessaries, particularly those designed with a supportive structure, can help manage stress urinary incontinence by providing additional support to the bladder and urethra.
Alternative to Surgery: Pessaries offer a non-surgical treatment option for women who are not suitable candidates for surgery or prefer to explore conservative management before considering surgical interventions.

The process of using a pessary involves fitting the device into the vagina by a healthcare provider, ensuring that it is comfortable and properly positioned to support the pelvic organs. Pessaries can be made of silicone, rubber, plastic, or other materials that are safe for vaginal use. They are typically removable, allowing for regular cleaning and maintenance.

It’s important to note that pessary use requires regular follow-up visits with a healthcare provider to monitor the device’s effectiveness, assess any potential complications (such as vaginal irritation or ulceration), and make necessary adjustments or replacements as needed.

Overall, pessaries are a valuable treatment option for women with pelvic organ prolapse or urinary incontinence, providing symptom relief and improving quality of life without the need for invasive surgery in many cases. The selection and fitting of a pessary should be done by a trained healthcare professional experienced in managing pelvic floor disorders. If you have specific concerns or questions about pessaries, it’s recommended to consult with a healthcare provider for personalized advice and guidance.

Why choose a pessary and what are the benefits?
Getting a pessary can offer several benefits for women experiencing pelvic organ prolapse or certain types of urinary incontinence. Some of the key benefits include:

Non-Surgical Treatment: Pessaries provide a non-surgical option for managing pelvic organ prolapse and urinary incontinence. This can be particularly beneficial for women who prefer to avoid surgery or who are not suitable candidates for surgical interventions due to medical reasons.
Symptom Relief: Pessaries can effectively relieve symptoms associated with pelvic organ prolapse, such as pelvic pressure, discomfort, and the sensation of a bulge in the vaginal area. They can also help reduce urinary leakage and improve bladder control in women with stress urinary incontinence.
Improved Quality of Life: By providing support to the pelvic organs and reducing bothersome symptoms, pessaries can significantly improve a woman’s quality of life. They can restore comfort, confidence, and the ability to engage in daily activities without discomfort or fear of leakage.
Avoidance of Invasive Procedures: Using a pessary allows women to avoid more invasive procedures, such as pelvic reconstructive surgery or surgical placement of mesh devices. Pessary fittings are typically less invasive and can be adjusted or discontinued as needed based on individual preferences and treatment outcomes.
Preservation of Fertility: For women who wish to preserve fertility or delay surgical interventions, pessaries offer a conservative approach to managing pelvic organ prolapse or urinary incontinence without impacting reproductive capabilities.
Customizable Options: Pessaries come in various sizes, shapes, and materials, allowing for personalized fitting based on a woman’s anatomy and specific condition. Healthcare providers can work with patients to find the most comfortable and effective pessary for their needs.
Cost-Effective: Compared to surgical treatments, pessaries are often more cost-effective, making them accessible to a broader range of patients who may not have the resources or insurance coverage for extensive surgical procedures.
Reversible Treatment: Pessaries are removable devices, which means they can be discontinued or changed if they are not well-tolerated or if the treatment goals change over time. This flexibility allows for ongoing management based on individual preferences and treatment outcomes.

It’s important to note that the benefits of getting a pessary should be discussed with a healthcare provider specializing in women’s health and pelvic floor disorders. The choice to use a pessary should be based on a thorough evaluation of individual symptoms, medical history, and treatment preferences, ensuring that the selected approach aligns with the patient’s goals and overall health.

What happens during the fitting and will it hurt ?
During a pessary fitting, a healthcare provider, typically a pelvic floor physical therapist, gynecologist, or urogynecologist, will assess your pelvic anatomy and determine the appropriate type and size of pessary for your condition. Here’s what you can generally expect during a pessary fitting:

Consultation and Examination: The process begins with a discussion about your symptoms, medical history, and any prior treatments you may have tried for pelvic organ prolapse or urinary incontinence. The healthcare provider will perform a pelvic examination to assess the degree of prolapse, if present, and to evaluate the vaginal canal size and shape.
Selection of Pessary Type and Size: Based on the examination findings, the healthcare provider will select a suitable type of pessary (e.g., ring, doughnut, cube) and determine the correct size that will provide optimal support without causing discomfort. Pessaries come in various shapes and sizes to accommodate different anatomies.
Insertion of the Pessary: Before inserting the pessary, the healthcare provider may apply a lubricant to make the insertion process more comfortable. The pessary is then gently placed into the vagina and positioned to support the prolapsed organs or address urinary incontinence.
Adjustments and Comfort Checks: Once the pessary is inserted, the healthcare provider will assess its position and ensure that it is comfortable and properly fitted. You may be asked to stand, sit, or walk to assess how the pessary feels during different activities.
Education and Instructions: The healthcare provider will provide detailed instructions on how to care for the pessary, including cleaning techniques and when to remove and reinsert the device for cleaning or examination
Your physician will demonstrate how to insert and remove your pessary.

Regarding discomfort and pain during a pessary fitting:

Discomfort: While a pessary fitting should not be painful, some women may experience mild discomfort or pressure during the insertion process, especially if the pelvic floor muscles are tense or if there is significant prolapse. Using a lubricant can help reduce discomfort.
Communication: It’s important to communicate openly with your healthcare provider during the fitting. If you experience pain or discomfort, inform your provider immediately so adjustments can be made to ensure comfort and proper fit.

After the fitting, you will be asked to schedule a 6 month follow-up visit to assess the pessary effectiveness and address any concerns or adjustments needed. If you have specific questions or concerns about the pessary fitting procedure, don’t hesitate to discuss them with your healthcare provider to alleviate any anxiety and ensure a positive experience.

**After your 6 month check up, it is required that you be seen annually to assess its effectiveness and address any concerns or adjustments needed**

Follow up and patient responsibilities

Scheduled Follow-Up Visits: Your healthcare provider will schedule follow-up appointments after the initial pessary fitting to assess its effectiveness and address any concerns or adjustments needed. Follow-up visits may be recommended at regular intervals, such as every few months or as needed based on your symptoms and comfort.
Pessary Maintenance and Cleaning: During follow-up visits, your provider will instruct you on proper pessary care and cleaning techniques. It’s essential to clean the pessary regularly with mild soap and water to prevent infections and maintain hygiene.
- Self or provider assisted removal of ring pessary is required every 2-4 months.
  - Wash with unscented soap and water prior to re-insertion
- Self removal of cube, or continence dish is daily.
  - Wash with unscented soap and water
  - Leave out for the evenings, and re-insert the next day
Assessment of Pessary Fit: At each follow-up visit, your provider will assess the fit of the pessary to ensure it is still providing adequate support and comfort. Adjustments may be made if necessary to optimize its performance.
Monitoring for Complications: signs of complications related to pessary use, such as vaginal irritation, abnormal discharge, or discomfort. Alert your provider immediately if you experience any complications you believe may be related to your pessary.

Patient Responsibilities:

Pessary Care and Hygiene: It is your responsibility to follow your provider’s instructions for cleaning and maintaining the pessary. Keep the pessary clean and dry to prevent infections and unpleasant odors.
Regular Self-Examinations: Perform self-examinations as recommended by your healthcare provider to monitor the condition of your vaginal tissues and ensure there are no signs of irritation or ulceration.
Notifying Your Provider of Changes: Inform your healthcare provider if you experience any changes in symptoms, discomfort, or problems with the pessary. Early detection of issues allows for timely interventions and adjustments.
Adherence to Follow-Up Visits: Attend all scheduled follow-up visits as recommended by your provider. These visits are essential for assessing the pessary effectiveness and addressing any concerns that may arise.
Communication with Healthcare Provider: Maintain open communication with your healthcare provider regarding your experience with the pessary, including any challenges or improvements you notice. Your provider can offer guidance and support based on your individual needs.

Discoloration:

Discoloration of a pessary, particularly over time with use, can be normal and is often not a cause for concern. Pessaries are typically made of medical-grade silicone, rubber, or other materials that can undergo slight changes in appearance due to exposure to vaginal fluids, lubricants, and natural body processes. Commonly, discoloration may occur as a result of:

Vaginal Secretions: The pH and composition of vaginal secretions can cause staining or discoloration of the pessary material over time. This is a natural occurrence and does not necessarily indicate a problem with the pessary effectiveness or safety.
Lubricants: The use of vaginal lubricants or moisturizers can also contribute to discoloration of the pessary. Certain lubricant ingredients may interact with the pessary material, leading to changes in color. We recommend a water based lube for all pessary handling AND intercourse
Normal Wear and Tear: Like any medical device, pessaries can experience normal wear and tear over time, which may manifest as changes in appearance, including discoloration.

By actively participating in follow-up care and adhering to your responsibilities, you can optimize the benefits of using a pessary and minimize the risk of complications. If you have any questions or concerns about your role in pessary care, don’t hesitate to discuss them with your healthcare provider for personalized guidance and support.

Why you may not qualify for a pessary

There are several factors and conditions that may disqualify or contraindicate the use of a pessary for managing pelvic organ prolapse or urinary incontinence. It’s important for healthcare providers to assess each individual’s medical history, pelvic anatomy, and overall health to determine the suitability of pessary use. Some common contraindications for pessary placement include:

Active Vaginal or Pelvic Infection: Pessary use is generally contraindicated in the presence of an active vaginal or pelvic infection, as the device may exacerbate the infection or interfere with healing. Treatment of the infection is typically required before considering pessary placement.
Severe Vaginal Atrophy: Women with severe vaginal atrophy, characterized by significant thinning and drying of vaginal tissues due to reduced estrogen levels (commonly seen in menopausal women), may experience discomfort or irritation with pessary use. Estrogen therapy or alternative treatments may be recommended before considering a pessary.
Vaginal Fistula or Perforation: The presence of a vaginal fistula (an abnormal connection between the vagina and another organ) or vaginal perforation (tear or hole in the vaginal wall) may contraindicate pessary placement due to the risk of complications or inadequate support.
Uncontrolled Pelvic Pain: Individuals with severe, uncontrolled pelvic pain or discomfort may not tolerate a pessary well and may require alternative treatment approaches tailored to their specific pain management needs.
Previous Pelvic Surgery Complications: History of complications related to previous pelvic surgeries, particularly those involving mesh placement (such as vaginal mesh for pelvic organ prolapse or stress urinary incontinence), may preclude the use of a pessary due to potential interference or risks of complications.
Anatomical Abnormalities: Certain congenital or acquired anatomical abnormalities of the pelvis or vagina may affect the feasibility or effectiveness of pessary placement. Individualized assessment by a healthcare provider is crucial in determining suitability for pessary use.
Patient Preference or Comfort: Some individuals may not tolerate or prefer pessary use due to personal preferences, lifestyle factors, or discomfort associated with the device. In such cases, alternative treatment options should be explored based on patient-centered care principles.

It’s important to consult with a knowledgeable healthcare provider specializing in women’s health, pelvic floor disorders, or urogynecology to assess your specific condition, discuss treatment options, and determine the most appropriate approach tailored to your needs and preferences. If you have concerns or questions about whether a pessary is suitable for you, don’t hesitate to discuss them openly with your healthcare provider for personalized guidance and recommendations.

Empowered Physical Therapy does not perform pessary fittings for individuals with any vaginal mesh implants or pelvic mesh devices. This policy is in place to prioritize patient safety and avoid potential complications or interactions between the pessary and existing mesh implants.

Patients with vaginal mesh implants seeking treatment for pelvic organ prolapse or urinary incontinence are encouraged to discuss alternative treatment options with their healthcare provider.