Pessaries can save the day!
by Carrie Seow, women's health physiotherapist
Prolapse and surgery has been in the news recently with the legal class action in Australia against Johnson&Johnson. With the horrific stories from many women of their pain and suffering after surgical mesh implant treatment of prolapse, surgery sounds like something to well and truly avoid.
Conservative or non-surgical management of prolapse is very successful and often prevents the need for surgery for women living with pelvic organ prolapse (POP). POP is the term to describe the sitting of a woman's bladder, uterus or bowel lower in the pelvis than should be. Pregnancy, child birth, menopause, much heavy lifting and age are all factors that can contribute to this very common issue. Did you know that 50% of women have a degree of POP, with many asymptomatic? This sagging of the organs can create pain, incontinence, heaviness and sometimes presentation of the organ outside of the vagina.
Conservative management for POP can include pelvic floor exercises and the prescription of pessaries. Surprisingly, not many women may have heard of these options in managing the symptoms of POP.
What is a pessary?
Pessaries come in different shapes and sizes. They are usually made of silicone, vinyl or latex and are inserted into the vagina (like a tampon) to support the walls of the vagina and uterus and reduce the strain to your pelvic ligaments. They offer support from below your organ to hold it in place. Women will often wear these all day. Some may just wear one for exercise and take it out immediately after. Some new mothers in early post natal weeks, may wish to return to running or other exercise before they have stopped breastfeeding or have full recovery of their pelvic floor strength and control. A pessary allows for a quicker return to exercise as she desires.
Pessaries are very easy to wear and to insert and remove yourself. Your women’s health physiotherapist will advise you of the type of pessary that would be most beneficial for your condition. Wearing a pessary should be comfortable, in fact you should not even feel that it is there.
What should I expect?
Your women's health physiotherapist is able to measure and fit you with a pessary if you have a POP. A pessary fitting consultation will involve finding the correct type and fit of pessary for your anatomy, and often you will need to try more than one pessary to find the right one that works for you. Your pessary can be self-managed – you will be taught how to insert, remove and care for your pessary.
Many women feel an instant improvement in their POP symptoms (heaviness, dragging, lower back pain) and with their bladder, bowel and sexual function by wearing a pessary. Another huge benefit is the confidence that the pessary offers a woman - to return to exercise altogether and to get back to running, jumping or other high intensity / impact exercises without leaking or experiencing pelvic discomfort.
As with all foreign objects that are inserted into the body, there are some risks with wearing pessaries including:
- Bacterial vaginosis. This is a type of bacterial infection that can be treated with antibiotics.
- Vaginal erosion. The pressure from the pessary may damage the internal skin of the vagina. This is why finding the correct size is important.
At your fitting and compulsory followup checks, your physiotherapist will discuss with you the relevant risks of wearing pessaries in further detail before fitting one and also advise you of signs and symptoms to watch out for.