Physio led Pessary Fitting
We are the 1st Physio Clinic in Northern Ireland to offer this service
What is a pessary?
A pessary is a silicone device that fits into the vagina to help support a prolapse of the uterus (womb), bladder and/or rectum (bottom of the bowel); or to help support the urethra (neck of bladder) to prevent stress urinary incontinence.
A prolapse develops when one or more of the pelvic organs loses its ligamentous support so that it pushes down into the vagina. Prolapse is commonly caused by childbirth, aging, or following pelvic surgery and may take years to develop. Changes due to ageing and repeated force such as chronic coughing or straining can gradually worsen the prolapse over many years until it becomes noticeable. Typically the symptoms of a prolapse are a feeling of heaviness or bulging around the vagina. It may also limit your ability to empty your bladder or bowel.
A pessary is a conservative, low risk measure to help support the prolapse - in short it's like an orthotic for the pelvic organs! It can be very useful to help you continue chosen activities which may typically worsen your prolapse or stress urinary incontinence, or it may be necessary to wear the pessary all the time. Your physiotherapist will help determine what the best course of action for you will be.
What kind of pessary will I use?
The decision about which type of pessary each woman should use depends what condition the pessary is being used for. The pessary has to be fitted correctly and it may take several tries to get the right one.
After the first fitting, you will need to return to our clinic in 2-3 weeks time to have the pessary checked. You will be taught how to self-manage your pessary and need to attend for periodic reviews.
Sometimes a different size or shape of pessary will have to be fitted, as things may improve or change over time.
Whilst every effort will be made to achieve the correct fit in some cases this may not be possible. Pessaries are the answer for many women - but not all!
Does the pessary cause any side effects?
Most of the potential side effects of using a pessary are very low risk. However, it’s important you are aware of them and can remove the pessary if required.
1 - You may notice more vaginal discharge than normal. Your vaginal discharge may also develop an odour.
2- Vaginal irritation is another possible side effect. Erosions may occasionally develop if the pessary is rubbing against the vaginal wall. Women who are past menopause may need to use oestrogen cream.
Can the pessary get lost or fall out?
The vagina is a closed tube so that the pessary can't go anywhere else inside the body. The pessary can fall out of the vagina, for example, if you strain on the toilet or bend or squat to lift something heavy. This usually means that your pessary is too small and needs to be replaced.
What else should I know?
Be sure to tell your physiotherapist straight away if you have any discomfort with the pessary or if you have trouble urinating or having a bowel movement.
· You should continue with pelvic floor exercises as prescribed by your physiotherapist
A pessary fitting appointment will take 1 hour and will include a full pelvic floor/pelvic organ assessment. Measurements will be recorded for a baseline and subsequent appointments will compare the measurements to monitor changes over time. Subsequent appointments will be 30 minutes.
A letter will be written to you doctor or specialist explaining the fitting and ongoing management plan. (Please advise us if you do not wish for us to communicate with other health professionals regarding your prolapse/pessary fitting).
If following your assessment the physio feels that a pessary is not the most appropriate course of action - you will only be charged the assessment fee.
Ciara is highly experienced in pessary fitting and set up the first Physio-Led Pessary Fitting service in the HSE in 2017. If you have any questions about the process please do not hesitate to get in touch.
