What is a Pessary?… and Do I Need One?
A pessary is a device that fits into the vaginal canal and provides support to tissues displaced by pelvic organ prolapse. This could mean tissues around the bladder, rectum, or uterus. A pessary is usually made of a comfortable silicone material that can be easily washed between uses. If you have the correct fit, you should not be able to feel you have it in… kind of like a tampon.
Sometimes when we experience prolapse issues we have symptoms of urinary leaking, difficulty having a bowel movement, or feelings of heaviness or that something is falling out. The ‘weighing down’ of our organs can leave our poor little pelvic floor feeling like it needs to work extra hard to hold up everything. When our pelvic floor is overworked it will no longer act as strong as it normally is, leading to more dysfunction.
So how do you treat prolapse?
One of our best ways of treating prolapse symptoms is working on making sure our pelvic floor is strong enough and functioning well to protect our body. It is also just as important to look at potential ways we are adding to the stress placed on our organs and pelvic floor coming from above. This is what we in the pelvic floor world call ‘pressure management’. There are so many different small things we can do to reduce the downward pressure placed on our organs and pelvic floor that can help with our current prolapse symptoms as well as prevent them from progressing to a point where we need surgery.
Ok - back to the scenario where our poor little pelvic floor is working so hard to hold everything up. Those pelvic floor muscles are eventually going to become overly tight and irritated because they are not getting much of a break during the day, just like any other overuse injury. Because of this, our pelvic floor is not going to be able to step in to do its normal everyday jobs as easily (read: maintain continence, hold everything UP). Sometimes we can fix this problem with internal manual techniques during our PT sessions in combination with certain postural adjustments (I know this sounds vague but can be explained in much more detail during our PT sessions). We can often benefit from the aid of a pessary to help hold ‘things’ up. This can not only alleviate the heaviness feeling we can sometimes feel, but can help with symptoms of urinary leaking, difficulty with bowel movements, as well as allowing our pelvic floor muscles to take a break and actually feel like they can relax for a change.
What if I only have the heaviness feelings or urinary leaking during strenuous exercise?
So many people describe symptoms only when running or during heavy exercise. This is when we want to look into what all is contributing to these symptoms. Is your running form contributing? How about holding your breath or other small postural things that could be improved with practice? Maybe the jumping is just too much for our already stretches-out ligaments that are holding our organs. A pessary can sometimes be excellent at resolving those symptoms and you may only need to use it during those strenuous activities!
Why not just have the surgery?
That sounds so easy right?? Have a hysterectomy or a bladder tack and be done with it. What if you are in your 40’s or 50’s? Most surgeries have a 10-15 year life these days - whether it is a total knee replacement or a bladder tack. It is often not discussed that if you have a hysterectomy and not any pre-emptive work to hold the bladder up, your chances of it falling over the next number of years is higher. I know a number of colleagues working in various areas of the women’s health field who are biding their time using a pessary until they finally decide on a surgery in order to avoid having multiple re-do surgeries for the same problem. Depending on the situation (each one is different), this can be a very smart move.
Don’t get me wrong. Surgery can sometimes be your best decision. No matter what, it is important to know all of your options as well as all of the repercussions for what you are deciding to do.
A perfect solution to avoiding surgery
Sometimes you just don’t want to have the surgery. Period. It may be because of other health conditions, a general aversion to surgery, or any other reason. A pessary can be a wonderful conservative option to correct prolapse symptoms.
Curious if a pessary is right for you? Contact me to discuss! I fit patients for pessaries in office.