Pessaries are medical-grade silicone devices that help to support the pelvic organs. This can be in order to treat pelvic organ prolapse or stress urinary incontinence. Jenny is a Pelvic Health Physiotherapist who has taken extra training to be able to fit pessaries. She is currently fitting ring with support, cube, dish with knob, and Gelhorn pessaries (see below). These are the most common types of pessaries.

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Ring with support pessaries:

These pessaries are used for mild to moderate pelvic organ prolapse and/or stress urinary incontinence. These are support style pessaries, which mean they act as a hammock or sports bra in order to hold the organs in. They are easy for the client to remove and clean at home, which is convenient for menstruation, sexual activity and maintaining vaginal tissue health. The ring with support and knob may be suggested especially for stress urinary incontinence as it may give additional bladder neck support.

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Gellhorn Pessaries:

These pessaries are space-occupying pessaries. This means that they give support by taking up more space in the vagina. Gellhorn pessaries are typically used to support moderate to significant pelvic organ prolapse. These pessaries are often left in 3 months at a time, giving continual support and relieving significant prolapse symptoms. Because they are difficult to maneuver at home, these pessaries are typically not used by women who are sexually active (via penetrative acts) as they block anything else from entering the vagina.

 

In order to purchase a pessary from a Pelvic Health Physiotherapist for ongoing use you have to get a prescription from a Medical Doctor (family doctor, GYN) or Nurse Practitioner. This is because these professionals have the training to assess your vaginal tissue health and they will be responsible for your ongoing pessary care. You can attend a Physiotherapy Pessary Fitting without your prescription from your Doctor to see if we can find a size that fits, and then obtain the referral/prescription afterwards if that works best for your schedule.

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Cube pessaries:

Cube pessaries can be used for mild prolapse with bladder leaking to significant prolapse. Cube pessaries are inserted and removed every day by the client. They are space-occupying pessaries so they have to be removed for penetrative sexual acts and menstruation. You need to very comfortable with maneuvering this pessary in and out of the vagina yourself for it to be a good fit for you to take home. 

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Dish with knob pessaries:

Used for mild to moderate prolapse, this style is similar to the ring with support in that it creates a hammock for the tissues, however it is a more rigid structure. 

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Concurrent treatment:

It is often advised to use a vaginal moisturizer (Gynatrof) and often a vaginal estrogen cream (Premarin) when you use a pessary in order to keep the vaginal walls health (elastic and moist). This helps to prevent adverse side effects with pessary use. Your MD or NP can prescribe this to you if they feel it is suitable when they give the prescription for the pessary.

 

Potential side effects:

The most common side effects are usually minor and easy to treat and rectify. They include

expulsion/falling out (33%), bacterial vaginosis (32%), increased vaginal discharge (30%), vaginal

bleeding or irritative symptoms (3-24%), UTI (13%), uncovered stress urinary incontinence and

difficulty with bowel movements. These are all reasons to remove your pessary.

  

Uncommon side effects include bleeding, incarceration or migration of the pessary (pessary

moving into vaginal wall or other neighbouring tissues). One small study showed increased risk

squamous cell vaginal cancer. These events are typically associated with improper care and

infrequent removal of the pessary. As a preventative measure, it is suggested you inform your

loved ones that you may be wearing a pessary to allow adequate medical management if you are

unable to share that information with your health team due to injury or illness.

 

Pelvic Health Physiotherapy Pessary Fittings:

 

At Ebb and Flow, Jenny takes 60-90 minutes for your pessary fitting appointments. This is because we want to have ample time to get your full history and to try as many pessary sizes and types as we needed to in order to find a good fit for you. We take the time to ensure your pessary resolves your symptoms and feels comfortable in lying, sitting, with walking, lifting and using the bathroom. We also go through how to insert and remove the ring with support pessaries so you know what to do yourself at home.

 

In order to purchase a pessary from a Pelvic Health Physiotherapist for ongoing use you have to get a prescription from a Medical Doctor (family doctor, GYN) or Nurse Practitioner. This is because these professionals have the training to assess your vaginal tissue health and they will be responsible for your ongoing pessary care. You can attend a Physiotherapy Pessary Fitting without your prescription from your Doctor to see if we can find a size that fits, and then obtain the referral/prescription afterwards if that works best for your schedule.

 

We follow up 1 week and 1 month after you have purchased and are wearing your pessary to make sure you are comfortable when wearing it and to ensure the vaginal tissues are staying healthy. After that, you are responsible for the maintenance of your pessary (ie cleaning) and following up with your doctor at 6-12 month intervals to ensure your vaginal tissues are healthy.

 

Pessaries are a conservative, often very effective and well tolerated option for management of pelvic organ prolapse and/or stress urinary incontinence. You can use a pessary in conjunction with Pelvic Physiotherapy exercises and treatment. If you have any questions about pessaries or other Pelvic Health concerns, feel free to email us at physio.appt@yourebbandflow.com.

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