This blog about pessaries is based on an Instagram Live with the lovely Anastasia Uvarova. Anastasia is a women’s health physio and pessary expert based in Cyprus. She regularly fits pessaries for women with prolapse or leaking. You can find the live here
What is a pessary?
A pessary is a medical device made of silicone. It’s inserted into the vagina and is used to relieve symptoms of pelvic organ prolapse, provide support for the pelvic organs and reduce leaking.
Many women are not aware that pessaries exist or how they could be helpful to relieve symptoms of prolapse. They can be a great solution as part of a wider pelvic health care plan. They are fitted by specialist pessary experts who ensure they are comfortable and appropriate for your needs.
There are different types of pessary. They are generally divided into space-occupying or support pessaries. Here are 3 examples of different types of pessaries.
A cube pessary is a space occupying pessary. It requires daily removal and is a great option for recreational and professional athletes for higher impact sports such as running. It may be a good option for women who have had a total hysterectomy.
The basic type of pessary that can be used in uterine prolapse and keep uterus in place reducing daily discomfort of prolapsed organs; reduction of heaviness in vaginal area.
Thick ring pessary is one of the most popular models, that provides extra support, occupies more space and can be used in presence or absence of cystocele (bladder prolapse) and rectocele (rectal wall prolapse).
Dish Pessary with Urethral support: Works like ring pessary, but the knob provides extra support to bladder neck therefore reducing urinary leaks on stress such as coughing.
Who could benefit from a pessary?
Here are some of the questions that Anastasia uses to assess suitability for a pessary.
- Are you happy to insert/remove and reinsert the pessary yourself?
- What kind of prolapse do you have? What stage of prolapse do you have? Pessaries generally offer more support/relief from a cystocele (bladder prolapse) and uterine prolapse.
- What is your menstrual status?
- Are you peri menopausal or post menopausal (declining oestrogen can affect the quality of the vaginal tissues)
- Do you have vaginal dryness or recurrent infections?
- What kind of exercise are you wanting to do? Higher impact exercise may require more support than lower impact or more gentle exercise.
You still need to look after your pelvic health
It can be tempting to think that a pessary is THE solution if you have a prolapse. However, you still need to look after your pelvic health.
- Pelvic floor exercises if appropriate
- Pressure management in exercise and everyday life
- Maintaining good bowel and bladder habits
- Awareness of your body’s (pelvic floor) capacity and limit
Questions from the audience...
Can pessaries fit so well they don't fall out? My mooncup falls out
A mooncup is a device to collect. It doesn’t provide the same level of support. Or fit exactly in the same way a pessary does. It’s useful to notice if your cup does fall out as it may suggest weakness of the pelvic floor or some level of pelvic organ prolapse.
Will wearing a pessary mean I might run too hard and miss symptoms?
Pessaries aren’t a magic solution. You still need to ensure good pelvic floor strength. Even if you are wearing a pessary, you still gradually build up intensity and distance. As Anastasia says. “no one canceled the gradual and mindful build-up of running”.
Can I wear a pessary in a hot tub?
This was a great question and the answer is yes! The temperature of the water does not affect the pessary (as they can be boiled in order to clean them). They are perfectly fine for swimming even though some water may enter the vagina.
Is a pessary suitable for me? I have hypertonicity and hypervigilance
Possibly! However, this is balancing the benefit of the pessary versus the anxiety around insertion and removal. An alternative may be external support such as EVB shorts.
Alpha Physio Care was established in July 2017 by Anastasia Uvarova, a UK qualified physiotherapist. The clinic has three main focuses: women’s health physiotherapy, musculoskeletal rehabilitation and long-term recovery and strength through clinical pilates, using highly skilled manual therapy to reduce immediate impact of the pain and targeted mobility and strength program to empower healing through movement.