Pelvic organ prolapse in women is very common. It is rarely considered serious but can cause discomfort and difficulties emptying the bladder. Many women consult their doctors about a bulge in the vagina and are diagnosed with prolapse.

The part of the vagina that has the bulge determines what the prolapse is called. The main treatment is physiotherapy, but a pessary may also help.

Causes of prolapse

Pregnancy and childbirth are associated with prolapse. Ongoing constipation, heavy lifting, cough, and obesity can make prolapse worse. Menopause may also accentuate pelvic floor issues.

Types of prolapse

• Cystocoele – bulging of the bladder into the vaginal wall
• Rectocele – bulging of the bowel into the vaginal wall
• Uterine – bulging of the womb into the vagina
• Procidentia – a combination, when the womb bulges out of the vagina

What is a pessary?

A pessary is a non-surgical method of supporting the prolapse and relieving symptoms. It fits into the vagina and supports the pelvic organs.

Why is a pessary needed?

A pessary helps support and correct the prolapse, which may be causing bladder or bowel symptoms, discomfort, or pain. By supporting the prolapse, it may relieve these symptoms.

Different types of pessary

There are many different pessaries, each with a different shape and size, designed to support different types of prolapse. Your health professional will discuss the best type for you. Common types include:

• Ring – supports cystocoele and 1st degree uterine prolapse
• Donut – supports cystocoele, 2nd degree uterine or vaginal vault prolapse
• Gellhorn – supports cystocoele, rectocoele, vaginal vault, or 2nd–3rd degree uterine prolapse
• Shelf/POPY – supports 2nd–3rd degree uterine prolapse
• Other – less commonly used in Forth Valley but available if needed

General risks of having a pessary

• Pessaries can occasionally cause vaginal discharge or discomfort.
• Pessaries must be changed regularly to reduce the risk of skin damage and vaginal bleeding.
• Rarely, a fistula could occur.
• Pessaries can improve or worsen urinary continence.
• Some women experience urinary retention (difficulty emptying the bladder).

How pessaries are fitted

After discussing your prolapse and pessary management, you will have a vaginal examination and the practitioner will fit the type and size of pessary thought best for you. This may feel a little uncomfortable, but once in place you should not be aware of the pessary and symptoms should be relieved. Sometimes, the first fitting is not quite right and you may need to return a few times to find a suitable fit.

What happens after the initial fitting?

• You will be asked to stay in the department for a short while to ensure you are comfortable, the pessary stays in place, and you can pass urine.
• You will be given instructions on how to contact the department if the pessary falls out or if you experience any side effects.
• Depending on the type of pessary, you may be able to self-manage or be discharged back to your GP for future changes (if available). Otherwise, you will need to return to hospital every 3, 4, or 6 months for changes.

What happens if the pessary is dislodged or falls out?

This is common, especially at the beginning. It sometimes takes a few tries to find the right size. If your pessary falls out or becomes uncomfortable, contact the urogynaecology nurse using the numbers on this page.

Can I have sexual intercourse with a pessary in?

Yes, you can have sexual intercourse if you have a ring pessary fitted. Other pessaries need to be removed before intercourse, and you may be able to remove and replace them yourself. Please ask your practitioner for advice.

What happens if the pessary affects my ability to pass urine or move my bowels?

The pessary should not interfere with urinating or moving your bowels. If it does, you may try to remove the pessary yourself or contact the urogynaecology nurse for removal. If you are unable to pass any urine at all, call the department or Ward 6 immediately.

Who to contact if you have any questions or concerns?

If you have concerns or need more information, contact the Gynaecology department and leave a message for the urogynaecology nurse on 01324 567145 (appointments) or 01324 566390 (Ward 6). The appointment line has an answerphone and is the preferred contact. Ward 6 is manned 24 hours for emergencies.

General advice on vulval/vaginal care when using a pessary

• Avoid perfumed soaps, shower gels, and bath additives.
• Vaginal wipes can cause irritation.
• Some vaginal discharge is normal with a pessary and rarely a sign of infection.
• Antiseptics are not recommended.
• If discharge becomes troublesome or you have vaginal itching, consult your doctor.
• Some pessaries can be re-used if thoroughly cleansed with non-perfumed soap.