Pessary Fittings for Prolapse: What to Expect
If you've recently been diagnosed with a pelvic organ prolapse, or you're experiencing vaginal heaviness, pressure or a feeling that something is “coming down”, you may have heard about using a vaginal pessary.
A pessary is a device worn inside the vagina to provide additional support for pelvic organ prolapse.
But how does a pessary fitting actually work? Is it uncomfortable? Can you exercise with one? And how do we work out which pessary is right for you?
Here are some of the questions we are commonly asked about pessary fittings.
What is a vaginal pessary?
A vaginal pessary is a removable device that sits inside the vagina to provide support for pelvic organ prolapse.
Pelvic organ prolapse occurs when one or more of the pelvic organs, such as the bladder, uterus or bowel, descend into the vaginal space.
A pessary helps provide additional support to these structures and may help reduce symptoms such as vaginal heaviness, pressure, dragging or a feeling of something coming down.
Pessaries come in a range of different shapes and sizes because there isn't one pessary that works for everyone.
What is a pessary fitting?
A pessary fitting is an appointment where we assess whether a pessary may be appropriate for you and determine which type and size provides the best support while remaining comfortable.
This isn't simply a matter of measuring you and choosing a pessary from a chart.
Different prolapse presentations, anatomy, symptoms and lifestyles can require different pessary styles.
Finding the right pessary can therefore involve some trial and error.
Who might benefit from a pessary?
A pessary may be considered for someone experiencing symptoms associated with pelvic organ prolapse, such as:
Vaginal heaviness or dragging
Pelvic pressure
A feeling of something sitting inside the vagina
Feeling or seeing a vaginal bulge
Symptoms that worsen after prolonged standing
Heaviness during or after exercise
Prolapse symptoms that become worse later in the day
Difficulty participating comfortably in exercise or everyday activities because of prolapse symptoms
Some people use a pessary regularly, while others may choose to use one primarily during activities that tend to aggravate their symptoms.
Do I need surgery if I have a prolapse?
Not necessarily.
There are different ways pelvic organ prolapse can be managed, and surgery is not the only option.
Conservative management may include pelvic floor rehabilitation, changes to bowel and bladder habits, pressure management, exercise modification and vaginal pessary support.
A pessary can be an option for people who want to manage their symptoms conservatively, aren't ready for surgery, aren't suitable for surgery or simply prefer a non-surgical option.
What happens at a pessary fitting appointment?
Your appointment begins with a detailed discussion about your symptoms, medical history, bladder and bowel function, activity levels and what you would like the pessary to help you do.
A vaginal assessment is then required to assess your prolapse and determine which pessary styles may be suitable.
A trial pessary is inserted and we assess how it feels and whether it provides appropriate support.
You may then be asked to walk around, squat, cough, bear down or perform movements that would normally bring on your prolapse symptoms.
We want to know that the pessary remains in position and is comfortable during real-life movement — not just while you're lying on the treatment table.
How do you choose the right pessary?
There are many different types and sizes of pessaries.
The most appropriate option depends on factors such as your prolapse presentation, anatomy, symptoms and what you want to be able to do while wearing it.
We generally aim for the smallest pessary that provides adequate support and remains comfortably in place.
Sometimes the first pessary we trial is perfect.
Other times, we may need to try a different size or style before finding the best option.
That's a normal part of pessary fitting.
What types of pessaries are available?
There are several styles of vaginal pessaries designed to provide different types of support.
Depending on your individual presentation, options may include ring-style pessaries and other supportive or space-filling designs.
Your practitioner will determine which options are appropriate to trial based on your assessment.
You don't need to know which pessary you need before coming in, that's what the fitting process is for.
Does having a pessary fitted hurt?
A pessary fitting shouldn't be painful.
You may notice some pressure or mild discomfort during insertion and removal, particularly while different sizes are being trialled, but once an appropriate pessary is in position you generally shouldn't be constantly aware of it.
If a pessary is painful or significantly uncomfortable, we need to know.
That may mean the size, style or position needs to be reassessed.
Can I feel a pessary once it's in?
Ideally, you shouldn't really notice it during normal daily activities.
A correctly fitted pessary should provide support without causing ongoing pain or discomfort.
During your fitting, we'll have you move around and check how it feels rather than assuming that because it looks right while you're lying down, it will be comfortable once you're moving.
Can a pessary fall out?
It can happen, particularly if the pessary isn't the ideal size or style for your body.
This is another reason why movement and bearing down are important parts of the fitting process.
If your pessary falls out once you're home, it doesn't necessarily mean pessaries won't work for you. Sometimes we simply need to reassess the size or try a different style.
Can I exercise with a pessary?
For many people, being able to exercise more comfortably is one of the reasons they choose to use a pessary.
Some people notice that their prolapse symptoms become more noticeable during walking, running, gym training, lifting or other forms of exercise.
A pessary may provide additional support during these activities.
Your practitioner can discuss your individual exercise goals and whether pessary support may be useful.
Do I have to wear my pessary all the time?
Not necessarily.
How often you wear your pessary depends on your symptoms, the type of pessary and your individual management plan.
Some people may use their pessary regularly throughout the day.
Others may choose to use it specifically for exercise, work, prolonged standing or other activities that tend to increase their prolapse symptoms.
Part of your appointment is working out how pessary use can fit realistically into your life.
Can I put the pessary in and take it out myself?
Many pessaries can be self-managed.
Where appropriate, we can teach you how to insert and remove your pessary yourself.
It can take a little practice initially, and we don't expect everyone to feel completely confident straight away.
Your practitioner will discuss what is appropriate based on the type of pessary you're using and your individual circumstances.
How do I clean a pessary?
If you're self-managing your pessary, you'll be given instructions about how to remove and clean it and how often this should be done.
Your practitioner will also discuss how frequently you should wear it and whether it should be removed overnight.
These recommendations can vary depending on the type of pessary and your individual circumstances, so follow the instructions provided specifically for you.
Can I have sex while wearing a pessary?
This depends on the type of pessary you're using.
Some pessary styles may allow penetrative intercourse while in place, while others need to be removed.
If maintaining penetrative intercourse while wearing your pessary is important to you, let your practitioner know during your fitting. This can be considered when discussing which pessary options may be suitable.
Can a pessary help with bladder symptoms?
Prolapse can sometimes affect bladder function, including how easily the bladder empties.
Supporting the prolapse with a pessary may change bladder symptoms for some people.
However, because changing the position of the pelvic organs can also affect bladder function, we will ask about your bladder symptoms and ensure you are able to urinate appropriately with the pessary in place.
If you notice new difficulty emptying your bladder after a fitting, you should let your practitioner know.
What happens after my pessary fitting?
A follow-up appointment is important after your initial fitting.
This allows us to check:
How comfortable the pessary has been
Whether it has stayed in position
Whether your prolapse symptoms have improved
How you're managing insertion and removal, if self-managing
Whether you've noticed any changes to your bladder or bowel function
Whether there has been any bleeding, discharge or irritation
Whether the pessary size or style needs adjusting
Sometimes a pessary that seemed perfect in the clinic doesn't quite work once you've worn it during normal life.
That's okay — pessary fitting can be a process rather than a one-off event.
Are there side effects from using a pessary?
Some people may experience changes such as increased vaginal discharge or irritation while using a pessary.
Regular review is important to make sure the vaginal tissues remain healthy and the pessary continues to fit appropriately.
You should contact your healthcare provider if you experience symptoms such as pain, bleeding, significant irritation, difficulty urinating or unusual or concerning discharge.
Does a pessary fix a prolapse?
A pessary doesn't permanently remove the prolapse.
Instead, it provides mechanical support while it is being worn, which may reduce symptoms and help you participate more comfortably in everyday activities.
Pessary use may form part of a broader prolapse management plan alongside pelvic floor rehabilitation, bowel management, exercise and strategies to manage pressure through the abdomen and pelvis.
Do I still need pelvic floor rehabilitation if I use a pessary?
Often, pessary support and pelvic floor rehabilitation can work alongside each other rather than being an either/or choice.
The pessary provides physical support, while pelvic health management may address factors such as pelvic floor function, strength, coordination, bowel habits, pressure management and exercise.
Your treatment plan will depend on your symptoms and individual goals.
Do I need to know what type of prolapse I have before booking?
No.
You don't need to diagnose your own prolapse or know which pessary you need before coming in.
A pelvic health assessment can help determine what is happening and whether pessary management may be appropriate.
If your presentation requires further medical or specialist assessment, we can also discuss this with you.
Pessary Fittings in Healesville and the Yarra Valley
At Yarra Valley Women's Health in Healesville, pessary fittings are individualised to your prolapse, symptoms and lifestyle.
The aim isn't simply to find a pessary that stays in.
We want to find an option that provides appropriate support, feels comfortable and helps you get back to the things you want to do.
Your fitting may involve trialling different sizes or styles, testing the pessary during movement and teaching you how to manage it yourself where appropriate.
If you're experiencing prolapse symptoms and wondering whether a vaginal pessary may be an option, you can book a pessary assessment and fitting to discuss whether it is appropriate for you.