A pessary is used to help some women manage a medical condition known as Pelvic Organ Prolapse or POP. It’s a condition where a woman’s pelvic organs push down on her vagina. This pressure can cause a variety of uncomfortable symptoms. Corrective surgery is an option, but patients might want to ask their providers if a pessary is the best way for them to manage a prolapse without surgery.
What Is a Pessary?
A pessary is one of the most frequently recommended treatment options for POP symptoms. The soft, removable prosthetic device is shaped like a ring. It is often made of medical-grade silicone so it will be durable. The patient inserts the ring into her vagina to support its internal structure. The purpose is to hold up the pelvic organs, so they will not put downward pressure on the vagina and cause discomfort.
What Is Pelvic Organ Prolapse?
Pelvic Organ Prolapse or POP results from weakened support muscles in a woman’s pelvic area. Those weakened muscles, tissue, and ligaments are not doing their job of holding up the bladder, uterus, or rectum. Any of those organs can drop down out of place and put pressure on a woman’s vagina. That pressing down effect can cause problems with urination, bowel movements, lower back pain, or other uncomfortable symptoms.
Why do these muscles stop being strong? They can weaken in some women because of pregnancy; difficult labor or delivery of a child; just being older; and loss of estrogen during a woman’s later years.
How Do I Know if a Pessary Is a Good Treatment Option?
Your provider will discuss a few options with you to help determine if a pessary is the best treatment for you to manage a prolapse. They will give you a physical examination and might order imaging tests to get a visual analysis of your pelvic area. Test results will help diagnose your condition and determine if the prolapse is severe.
A pessary is a low-cost treatment. It is a minimally invasive option, which helps a patient avoid surgery and potential risks that go with it. There are two types of pessaries:
- Support Pessary. The support pessary is often the first option recommended by your provider. The most common support pessary is a ring-shaped device, designed to be flexible..
- Space-Filling Pessary. The space-filling pessary is used when a patient cannot retain the support pessary.
A pessary might be the best treatment option for a patient in the following situations:
- She has significant comorbid factors if she undergoes surgery
- The goal is to avoid a second operation after a previous one
- The patient had POP or cervical insufficiency during pregnancy
- The patient wishes to have a baby in the future
Will My Provider Fit Me for a Pessary?
Pessaries come in different shapes and sizes to obtain the best fit. Your provider will work with you to make sure the pessary works effectively for your body. You will have to see your provider for regular follow-up visits. Your provider will offer guidance on the best way to remove the pessary and to regularly clean it.
Should I Consider Surgery to Treat Prolapse?
If you have severe symptoms and non-surgical treatments are not working, you might consider having surgery. Here are your two main options:
- Obliterative surgery. This procedure narrows an area within the vagina or closes it off. The intent is to provide more support to the organs that dropped, so they will not put pressure on the vagina. Be aware that after this procedure, you might not be able to have intercourse in the future.
- Reconstructive surgery. This procedure tries to repair the weakened pelvic floor area and to move the organs that pressed down back to where they originally were. A surgeon can make incisions in the vagina or to the abdomen for this reconstructive procedure.
If you have surgery to treat POP, you should plan to take a few weeks off from work during the recovery process. You will want to avoid any strenuous, physical activities for six weeks while you heal. Your provider can help you determine if you can avoid surgery and if a minimally invasive pessary is the best option for you to manage a prolapse.