What is a pessary?
A pessary is a soft, silicone device placed into the vagina to support the uterus, urethra, bladder, and rectum. There are many shapes and sizes depending on the type of prolapse and the condition of the pelvic floor muscles. Pessaries are sized and fitted typically by OB/GYNs, Urologists and trained pelvic physical therapists.
What are they used for?
Think of it like a “sports bra” or a splint to take pressure off your fascia and support your pelvic organs: the bladder, rectum, and cervix. Fascia is connective tissue that does not contract like muscles, but it does have an important supportive role that can be altered following pregnancy or menopause. Pessaries are used to help treat and manage symptoms of pelvic organ prolapse and certain types of urinary incontinence.
Prolapse Management: Why are they helpful? Can’t I just strengthen my muscles?
Using a pessary is not cheating. It may actually help your pelvic floor function better. Why? If the pessary can support the organ, it is preventing excessive stretching of the fascia over time. This gives us a better opportunity to strengthen the pelvic floor muscles underneath the organs. If the organs have dropped down to resting on the muscles, it typically results in a state of increased tension and eventually muscle fatigue.
Let me share some examples with you:
Think of a woman who has given birth in the past few years, she knows she has prolapse and complains of heaviness, especially around her menstrual cycle and when carrying her kids. She is fit for a pessary, and taught proper breathing, core strength, and pelvic floor awareness. She has internal pelvic floor myofascial release to decrease tension, pain and improve strength. She combines these exercises with wearing the pessary daily for 6 months and her symptoms resolve. We need more research in this population, but it is probable that a pessary may actually help the pelvic fascia regain its supportive qualities when worn postpartum.
Now think of a 49-year-old woman, she is a runner. She knows menopause is coming soon (hello major hormone changes). She can run 4-5 miles, but near the end of every run she has leakage. She has a strong pelvic floor, great running mechanics, great core strength. The leakage in this case is due to her urethral fascia moving too much- this is not a muscular issue! She is fit for an incontinence pessary, she is taught how to insert and remove it on her own. Now when she works out, she inserts the pessary and is able to run and jump easily with no leakage.
Conclusion
The goal of this blog is to simply empower you with knowledge about one of the great options out there to help with pelvic organ prolapse. We are trained to size and fit pessaries at Peak Pelvic Health. If we think you are appropriate for using one, we always co-manage your care alongside your OBGYN or Primary Care Physician.