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Pessaries Demystified: Your Guide to Non-Surgical Treatment for Prolapse
- Gaia Women's PT and Wellness
- Aug 4
- 5 min read
Updated: Aug 10
If you've been told you have pelvic organ prolapse, you've probably heard the word "pessary" thrown around. Maybe your doctor mentioned it as an option. Maybe a friend uses one. Or maybe you stumbled across the term while Googling your symptoms at 2 AM (we've all been there, girl).
But what exactly is a pessary? How does it work? Can you exercise with one? What about sex? And most importantly, will it actually help?
Let's demystify this often-misunderstood treatment option and help you understand whether a pessary might be right for you.
What Is a Pessary, Anyway?
Think of a pessary like an orthotic for your pelvis. Just as an arch support helps a flattening foot, a pessary provides support for prolapsed pelvic organs.
A pessary is a removable silicone or plastic device that's placed in the vagina to support the pelvic organs when the muscles and tissues that normally hold them in place have weakened. They come in various shapes and sizes designed to address different types and severities of prolapse.
Pessaries have been used to treat pelvic organ prolapse for centuries, and for good reason: they work. Research shows that prolapse symptoms resolve in 70 to 90% of patients who use a pessary, and satisfaction rates are consistently high.
Who Should Consider a Pessary?
Pessaries are an excellent option for many women with prolapse, including those who:
Want to avoid or delay surgery
Are not good surgical candidates due to other health conditions
Need additional support through pregnancy
Need additional support beyond physical therapy interventions
Want a conservative, reversible treatment option
Types of Pessaries for Prolapse: Finding the Right Fit
Pessaries fall into two main categories: support pessaries and space-occupying pessaries.
Ring Pessaries are the most commonly used type and often the first choice for clinicians. They're easy to insert and remove, fit many women comfortably, and allow for sexual intercourse with the pessary in place. Ring pessaries work well for many stages of prolapse and can be self-managed by most women.
Ring Pessaries with Support are similar to regular ring pessaries but have additional support structures. They're closed with perforations, which prevents the uterus from prolapsing through the ring, making them useful for more advanced prolapse.
Cube Pessaries work through suction and are good options for women with severe prolapse or a wide vaginal opening.
The Fitting Process: What to Expect
Pessary fitting is a little bit art and a little bit science. Here's what typically happens:
Initial Assessment: Your provider will evaluate your prolapse stage, measure vaginal dimensions, and discuss your lifestyle, sexual activity, and ability to self-manage the device.
Trial Fitting: Starting with an estimate based on your anatomy, your provider will fit you with a pessary. You'll be examined in both lying and standing positions, and asked to walk, sit, cough, and bear down to ensure the pessary stays in place and feels comfortable. The goal is to fit you with the largest pessary that's comfortable, as this provides the best support.
Walking It Out: You'll walk around, use the bathroom, and test how the pessary feels during normal activities. You should not be able to feel it when it's properly fitted.
Self-Management Training: If your pessary type allows for self-management, your provider will teach you how to remove and reinsert it.
Follow-Up: You'll check in about the pessary at your next scheduled pelvic floor PT appointment to ensure it's still fitting well, assess comfort, check for any irritation, and address any new symptoms.
Living with a Pessary and Prolapse: The Real Talk
Let's address the questions most women have but might feel awkward asking.
Can I exercise with a pessary? Yes! One of the great benefits of pessaries is that they can enable you to be more active. Some women even use pessaries specifically for exercise, inserting them before workouts and removing them afterward. This can help manage symptoms and prevent further stress on the pelvic floor during running, lifting, or whatever exercise you enjoy.
What about sex? This depends on the type of pessary. Ring pessaries can typically stay in place during intercourse, and research shows that sexual function is not negatively affected by pessary use. Space-occupying pessaries need to be removed before intercourse. If you're sexually active, this is an important consideration when selecting a pessary type. If you can self-manage your pessary, you can remove and reinsert it as needed for sexual activity.
What about discharge and odor? Some vaginal discharge is normal with pessary use. Regular cleaning helps manage this. If you notice a foul odor or unusual discharge, contact your provider, as this could indicate infection or the need for a pessary change. Postmenopausal women are often prescribed vaginal estrogen cream to keep vaginal tissues healthy and reduce the risk of irritation or erosions.
Can I feel it? When properly fitted, you should not feel your pessary during daily activities. If you can feel it consistently, it may need to be refitted.
How Well Do Pessaries for Prolapse Work?
The research is compelling. Studies show that women utilizing pessaries:
experience significant improvement in prolapse symptoms
see improvement in urinary symptoms
experience resolution of bowel symptoms
Over 90% report satisfaction with their pessary
50 to 80% of women who are successfully fitted continue using their pessary at 1 year
Importantly, research shows that pessary use produces similar outcomes to surgery at 1 year in terms of prolapse symptoms, sexual function, and quality of life, but without the risks and recovery time of surgery.
Our Pessary Fitting Program at Gaia Women's PT
At Gaia Women's Physical Therapy, we offer comprehensive pessary fitting as part of our pelvic health services. Our approach combines:
Individualized Assessment: We take time to understand your specific prolapse symptoms, lifestyle, goals, and concerns before recommending a pessary type.
Expert Fitting: Our specialized pelvic floor physical therapists have extensive training in pessary fitting and management.
Integrated Care: We combine pessary fitting with pelvic floor physical therapy to address the underlying muscle dysfunction that often accompanies prolapse. This integrated approach can improve your outcomes and may help prevent prolapse progression.
Education and Support: We ensure you understand how to care for your pessary, recognize potential issues, and feel confident in your ability to manage it.
Ongoing Follow-Up: We schedule regular check-ins to ensure your pessary continues to fit well and your symptoms remain well-managed.
Pessaries and Pelvic Floor PT: Better Together
Here's something important that often gets overlooked: pessaries work even better when combined with pelvic floor physical therapy.
While a pessary provides mechanical support for prolapsed organs, pelvic floor PT addresses the underlying muscle dysfunction, improves coordination, and can help prevent prolapse progression. Research shows that pelvic physical therapy is effective for mild to moderate prolapse, and combining it with pessary use can optimize your outcomes.
At Gaia, we view pessary fitting as one tool in a comprehensive approach to pelvic health that may also include manual therapy, therapeutic exercises, lifestyle modifications, and education.
Is a Pessary for Prolapse Right for You?
If you're experiencing symptoms of prolapse, such as a feeling of bulging or pressure, difficulty with bladder or bowel function, discomfort during activity or sex, then a pessary might be worth considering, especially if you want to avoid surgery or aren't a good surgical candidate.
The best way to find out is to talk with a pelvic floor specialist who can assess your individual situation and discuss all your options. Pessaries aren't the right choice for everyone, but for many women, they provide significant relief and improved quality of life without the need for surgery.
Remember: choosing a pessary doesn't mean you can never have surgery later if you change your mind. It's a reversible option that gives you time to make the best decision for your body and your life.
If you're curious about whether a pessary might help with your prolapse symptoms, we'd love to talk with you about our pessary fitting program and how it can be integrated with comprehensive pelvic floor care.
