Pessary Fitting/Management

What is a vaginal Pessary?

A vaginal pessary is a flexible removable device made of vinyl or silicone that goes inside your vagina. It is used to support a prolapse or improve symptoms of stress urinary incontinence. Pessaries come in a variety of shapes and sizes. They are comfortable and should not be felt at all. Certain pessaries are removed daily and others can be left in place for 4-6 months depending on the type of pessary used. You will also be taught to manage a pessary yourself, which includes taking it in and out.

Why might I need a pessary?

A pessary can help to provide relief from symptoms of prolapse and stress urinary incontinence, allowing you to return to your normal active lifestyle and previous levels of exercise. They can be used if you would prefer to avoid surgery or are awaiting surgery. You may be recommended to try a pessary if you have a prolapse and want to have children or if surgery is not a safe option due to your health. A pessary should be used alongside pelvic floor exercises and it is important to continue to follow advice on lifestyle management such as weight loss and avoiding constipation.

The benefits of a pessary may include, but not limited to:

Improved pelvic organ support; Improved comfort and function and quality of life; Improved bladder and/or bowel emptying; Improved pelvic floor muscle function; Reduced urinary incontinence; Preventing or avoiding surgery.

Your pessary is a good fit for you if:

You are not aware of it when wearing it; it feels supportive; you can empty your bladder and bowels fully; it is easy to remove every night and re-insert in the morning; it reduces or clears your symptoms of prolapse and/or incontinence; it enables you to be more active and feel more comfortable; it helps to prevent or avoid surgery.

What can you expect from your appointment?

Pessary Fitting:
Discussion about the use of a pessary and its complications, as well as explanation of the process of fitting a pessary. If you are breastfeeding or post-menopausal you may need to use a vaginal oestrogen alongside your pessary.

Full assessment of your pelvic floor issues, including taking a thorough history as well as a whole-body assessment. This will involve assessment of your breathing, alignment and abdominal engagement, as well as an internal vaginal examination to review the strength and coordination of your pelvic floor muscles and measure your prolapse.

Discussion of which pessary is most suitable for you, considering your symptoms, lifestyle and the examination findings. Following this your pessary will be fitted.

Fitting of the pessary may take several tries to get the right size for you. A standing examination will be completed once it has been fitted to check that it is in the correct position. Following this, you will be asked to walk around to ensure the pessary feels comfortable and stays in place. You will also be asked to urinate to make sure that you are able to void without difficulty or obstruction. If you are more active you may be asked to run, jump, lift weights or complete movements specific to the exercise you complete.

We will also teach you to self-manage your pessary, showing you how to take it in and out.

After the first fitting you will need to come back to the clinic at a minimum in 3-4 weeks to have the pessary checked. This will allow you to ask any questions you may have and resize the pessary if indicated. Following this you will then need to return to the clinic after 3-6 months for it to be reassessed again. Then you will need to return to the clinic every 6-12 months. Additionally you will be required to co-manage with Reborn Pelvic Health & Wellness and your PCP, GYN, OB or Midwife for routine annual (minimum every 12 months) for reassessment.