Pelvic Organ Prolapse, also known as POP can be a frightening diagnosis when you don’t have all of the facts. (I wrote a blog all about POP here). Often we associate surgery or mesh as the go-to treatment. Mesh has been in the news a lot in the past year, and for some, a sling procedure is the right treatment for that person for many reasons. However, it doesn’t have to be all or nothing. In addition to pelvic floor physical therapy, a very viable option that has been getting more attention in the pelvic floor world, is the humble pessary.
What is a pessary?
A pessary is a silicone or plastic device designed to support prolapsing pelvic organs. I like to think of it as a sports bra for our organs. They come in many shapes and sizes with different jobs. One of the most common pessaries is a ring pessary.
Who is a pessary for?
A pessary can be helpful for any woman:
- whose anatomy post vaginal delivery can hold the pessary in a comfortable position, where she doesn’t feel it and it reduces her prolapse (i.e. she feels better when it’s in).
- Who can be taught to self-manage the pessary (taking it in/out, cleaning, etc)
- Who is able to have local estrogen if she is post-menopausal or breastfeeding.
- A woman of ANY age (a pessary is not just for old ladies!)
Why a pessary?
Research shows that if screened early, there can be a 40% symptom resolution with conservative measures (PT, lifestyle modifications and pessary) and watchful waiting (1). A recent study demonstrated that women who receive pelvic floor muscle training show a greater improvement in POP symptoms and a reduction on POP severity (2). Interestingly, in one published case study, a woman with significant POP of her bladder, bowel and uterus, used a pessary in combination with pelvic floor strengthening and completely reversed her POP in approximately 8 months (3).
It is important to know all of your options, and often a pessary is never mentioned, or women are given a pessary with the caveat of “until you’re ready for surgery.” One of the reasons it’s not offered to young, active women is because in medical training, pessaries are often recommended for women who are not able to have surgery and aren’t able to manage the pessary well (i.e. older women), so there is a belief that “pessaries don’t work” or “you’re too young for a pessary.”
A physical therapist can not fit pessaries in the U.S., however we can help educate and discuss if a pessary would be right for you. Most importantly, we can help you strengthen and learn ways to decrease stress to your POP in everyday activities as well as working towards higher level activities like jumping and running, with or without a pessary.
“After a few sessions with Allison, consistent homework on my end and a pessary to help support my body, I am now leak free. It feels almost unbelievable to me that I can run (hard, uphills or even when really hydrated) without any problems. I didn’t realize how interfering it was until it wasn’t a problem anymore. I’m even heading to the trampoline park with my kids…to jump. That’s right. I’m gonna jump on a trampoline and I’ve had 3 kids. If that’s not testament to Allison amazing skills as a therapist, I don’t know what is.”J.F. Client testimonial
Below are some great resources to read more about pessaries and prolapse.
- PESSARY STORIES -YES! USING ‘SHOUTY’ LETTERS FOR A REASON this is a great blog with a quick overview of pessaries and a few patient stories on their experience with pessaries.
- Association for Pelvic Organ Prolapse Support: APOPS
- International Urogynecological Association: IUGA
Think you might have a prolapse or frustrated with your lack of progress? Let’s chat! I offer a free phone conversation so we can discuss you specific issues, what your goals are and I’ll discuss my approach and a strategy to get you there. Schedule a Phone Conversation.
- Hagen, S. (2017) Should we screen for prolapse symptoms in primary care?. BJOG: Int J Obstet Gy, 124: 520. doi:10.1111/1471-0528.14067
- Li C et al (2015) The Efficacy of PFMT for pelvic organ prolapse: a systematic review and meta-analysis.
- Nemeth, Z et al (2011) Complete recovery of severe postpartum genital prolapse after conservative treatment- a case study. Int Urogynecol J, 22:1467-1469