What Is a Pessary Used For?
A pessary is a device that manages pelvic organ prolapse without surgery. You insert the device into your vagina, where it supports your uterus, vagina, bladder, or rectum. Some types of pessaries also reduce stress urinary incontinence.
How Does a Pessary Work?
Prolapse occurs when your pelvic floor muscles and connective tissues weaken, causing your pelvic organs to “drop” or “fall” into your vagina. A pessary provides support and structure to stop these organs from dropping into your vaginal opening.
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Pros & Cons of Pessary for Prolapse
A pessary offers an alternative to prolapse surgery. A pessary is a good option if you want to avoid or delay surgery or can’t have surgery due to medical complications. Talk to your provider to weigh the pros and cons of a pessary based on your situation.
Types of Pessaries
Pessaries are available in many types and sizes. You can remove and reinsert some types of pessaries yourself. With other styles, your provider needs to do this for you. You can also have sex with some types of pessaries, while you’ll need to remove others beforehand. Different pessary styles serve different purposes:
Ring and Mar-Land pessaries. These styles work for early-stage prolapse. These pessaries are round and may be equipped with a knob or support wall to help relieve urinary incontinence.
Donut and cube pessaries. These styles are shaped as their names imply and work well for mid-stage prolapse.
Gellhorn or Gehrung pessaries. Though these pessaries work better for advanced prolapse, they can be difficult to insert and remove on your own. These have two segments. One segment is round and concave to create suction, while the other end is shaped like a stem.
Your provider will recommend a type of pessary based on certain factors:
- Incontinence level
- Prolapse severity
- Sexual activity
- Whether you have a uterus
Pessary Fitting
During a pessary fitting, your provider will examine your vagina and determine the size of pessary that’s right for you. After they place the pessary, you’ll walk around the exam room and do simple exercises to ensure the device fits comfortably. The appointment takes about 30 minutes. If the pessary comes out after you leave the clinic, your provider will work with you to find one that fits better.
How to Insert a Pessary
Start by washing your hands. Next, fold the pessary in half so the curved edge points toward the ceiling. Place a small amount of lubricant on the edge of the pessary.
Hold the pessary in one hand and use your other hand to spread the lips of your vagina. Gently push the device as far into your vagina as it will go. You can insert the pessary while standing with one foot propped up, squatting, or sitting.
These instructions may vary slightly depending on the type of pessary you have. Your provider will give you specific pessary insertion instructions.
How to Remove a Pessary
After washing your hands, find the rim of your pessary with your finger. It will be just under the pubic bone near the front of your vagina. Hook your finger over or under the rim and angle the device downward. Then, gently pull it out of your vagina.
Pessary Side Effects
You shouldn’t have side effects from a pessary. If you experience pain or discomfort, your pessary doesn’t fit correctly. See your provider for a different type of device or to learn to position it more comfortably.
Can a Pessary Affect Bowel Movements?
A pessary should not interfere with bowel movements. However, if your pessary is too large, you may experience constipation. Additionally, a pessary could make chronic constipation worse. Your provider can fit you with a new pessary or recommend strategies to address constipation.
Bleeding with a Pessary
A pessary should not cause vaginal bleeding. However, if you notice pink stains or blood in your underwear, the pessary may be rubbing against your vaginal wall. Tell your provider, and they can recommend another type.
Pessary Discharge
When you wear a pessary, it’s normal for your body to create a white or yellow discharge (fluid). To reduce it, your provider may recommend using an estrogen hormone cream. However, if the discharge changes colors, tell your provider right away, as it could be a sign of infection.
Pessary Cleaning and Care
Pessaries are made from silicone, a soft, non-absorbent material. Your provider will tell you how and when to clean your device. In general, you can leave a pessary in for two weeks. You should remove it twice a month and leave it out overnight. Rinse your pessary in warm water. If it has a mild odor, wash it with mild soap and allow it to dry. Don’t use antiseptics or harsh cleansers.
If you can’t remove your pessary on your own, you should see your provider every three or four months for pessary management.
How Many Years Can You Use a Pessary?
If your pessary fits comfortably, you can use it for years. Your pessary may become discolored over time, but it does not mean you should replace the device.
Does a Pessary Prevent Further Prolapse?
A pessary does not fix a prolapse or keep it from getting more significant. Talk with your provider about ways to keep your prolapse from increasing, such as avoiding heavy lifting, managing your bowels, and doing pelvic floor exercises.
Make an Appointment
Make an appointment with a University of Utah Health pessary specialist by calling 801-213-2995. You only need a referral if your insurance company requires one.
To refer a patient to our Women’s Health Services, please fill out our online referral form or call 801-581-2897.
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When Should You See a Urogynecologist?
Do you have trouble with an overactive bladder, feel pressure in your pelvis, or feel like your vagina, bladder, uterus, or rectum has dropped, causing a bulge or pressure? You do not have to suffer through these symptoms. They are treatable.
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