16036 Pessaries

Overview

A pessary is a soft, flexible device that is placed inside the vagina to hold the vaginal walls and nearby pelvic organs in a better position. It is most often used to treat pelvic organ prolapse, where organs such as the bladder, womb or bowel drop down because the muscles and tissues that normally support them have weakened. Some types of pessary are also used to help with urine leaks when you cough, sneeze or exercise. A pessary does not cure prolapse, but it can ease symptoms and help you feel more comfortable day to day. Most pessaries are made of medical-grade silicone, are removed, cleaned and put back by a doctor or nurse at check-ups, and some can be taken out and cleaned at home.

Yes. Pelvic organ prolapse is very common, especially in people who have had vaginal births, and pessaries have been used safely for many decades. Many people use one for years and get on well with it.

Pessaries are used mostly by adult women. They are more often needed after menopause, after one or more vaginal births, or in people with long-term coughing, constipation, heavy lifting or weaker connective tissue. They are not used in children.

Symptoms

Common symptoms

• A feeling of heaviness, dragging or 'something coming down' in the vagina
• A bulge you can feel or see at the vaginal opening
• Discomfort or pressure that is worse at the end of the day, after standing, or after lifting
• Needing to pass urine often, urgently, or leaking when you cough or sneeze
• Difficulty emptying your bladder or bowels, or needing to press on the vaginal wall to go
• A feeling that your vagina is loose or that tampons do not stay in place
• Lower back ache that eases when you lie down
• Vaginal discharge or soreness from the pessary itself, which is common and usually manageable

Symptoms in children

• Pessaries are not used in children or teenagers
• If a child has pelvic pain, a bulge, or bladder or bowel changes, speak to a doctor rather than using any adult device

Symptoms in older adults

• Symptoms may come on gradually and be put down to 'just getting older'
• Vaginal dryness after menopause can make a pessary feel uncomfortable or cause discharge and soreness
• Some people need help inserting or removing the device, or need more frequent check-ups
• Memory problems or limited movement can make it harder to keep up with routine pessary changes, so it helps to involve a carer or district nurse

Causes

Main causes

• Pelvic organ prolapse happens when the muscles and connective tissues that support the pelvic organs become weak or stretched, so the organs drop down into or out of the vagina
• Pregnancy and vaginal birth stretch and sometimes injure the supporting tissues
• Low levels of the hormone oestrogen after menopause make the vaginal walls thinner and less elastic
• Long-term pressure inside the abdomen from a lasting cough, constipation, heavy lifting or being overweight
• Some people have naturally weaker connective tissue, or have had pelvic surgery such as a hysterectomy

Risk factors

• Having had one or more vaginal births, especially with long or difficult deliveries
• Being past menopause
• Getting older and having weaker pelvic muscles
• Long-term cough, such as from smoking or a lung condition
• Long-term constipation and straining
• Regular heavy lifting at work, at the gym or at home
• Being overweight
• Previous pelvic surgery
• Conditions that affect connective tissue, or a family history of prolapse

When to see a doctor

See a doctor urgently if:

• You cannot pass urine at all, or your bladder never feels empty
• The pessary is stuck, painful or causing bleeding
• You have a new bad-smelling discharge or signs of infection such as fever
• You have severe pelvic or lower back pain

Book a routine appointment if:

• You feel a heaviness, dragging or bulge in the vagina
• You have bladder or bowel symptoms that affect your daily life
• You are finding the pessary uncomfortable, or it keeps coming out
• You have discharge or soreness that is getting worse
• You are due a pessary check, clean or change
• You are thinking about other options such as pelvic floor therapy or surgery

Diagnosis

A doctor or nurse will usually ask about your symptoms, your births, your general health and any medicines, then offer a gentle internal examination to see whether the vaginal walls or pelvic organs have dropped and how much. This helps them choose the right pessary type and size. You can ask for a chaperone, and you can stop the examination at any time.

Tests that may be done

• Internal (vaginal) examination to check the position and movement of the pelvic organs
• A 'try it' fitting, where a pessary is put in so you can see how it feels and whether it stays in place
• A urine sample to rule out infection if you have bladder symptoms
• Sometimes a bladder scan or bladder tests if leaking or poor emptying is a big problem
• Rarely, referral to a specialist gynaecology or urogynaecology service for more detailed tests

What to expect at your appointment

A first appointment usually takes 15 to 30 minutes. If you are offered a pessary, you may try one in the clinic the same day. You may feel a little pressure or mild discomfort going in, but it should not be painful once it is in place. Your clinician will check it fits well, ask you to walk, cough and empty your bladder, and go through how it will be looked after and when you need to come back.

Treatment

A pessary is one of several ways to manage prolapse and bladder leaks. It works by holding the vaginal walls up, giving support from inside. There are many shapes and sizes, such as ring-shaped supports and other designs, and your clinician will try different ones until you find something comfortable. Some people wear a pessary all the time and some only when needed, such as for exercise. Many people also do pelvic floor exercises and make small lifestyle changes alongside it. If a pessary does not suit you, or if symptoms are troublesome, other options include specialist physiotherapy, a procedure to support the pelvic organs, or surgery.

Self-care at home

• Always have your pessary checked, cleaned or changed when your clinic advises, as leaving it too long can cause irritation or sores
• If your clinician says you can remove and clean it at home, wash your hands first, follow their instructions, and use warm water or a mild, unperfumed cleanser
• Wear cotton or breathable underwear and avoid perfumed soaps, douches or sprays in the vaginal area
• Empty your bladder regularly and avoid holding on for long periods
• Avoid heavy lifting and straining on the toilet; if you must lift, bend your knees and keep the load close
• Do your pelvic floor exercises as shown by a physiotherapist or nurse
• Keep a note of any changes in discharge, comfort or bladder habits to mention at your next visit
• If the pessary falls out or feels wrong, contact your clinic rather than trying to force it back

Medical treatments

Pessaries themselves are the main device-based treatment and come in many shapes and sizes to suit different bodies and symptoms. A healthcare professional fits it, then reviews it, usually within a few weeks at first and then every few months. Some people are taught to take it out and clean it themselves between visits, while others have it changed at the clinic. Where vaginal tissue is thin and dry, a clinician may also discuss other treatments to keep the skin healthy and comfortable. If prolapse or bladder leaks are still troublesome, other options include specialist pelvic floor physiotherapy, bladder training and, in some cases, surgery. Your clinician will discuss what suits your situation, and you can ask your pharmacist about any treatment questions.

When is surgery considered?

Surgery may be considered if a pessary does not control your symptoms, keeps causing problems, or if you would rather have a permanent repair. It may also be offered if the prolapse is severe or affecting your bladder or bowel. Surgery is not right for everyone and depends on your age, health, whether you may have more children, and your own preferences. Your specialist will explain the benefits and risks of each option so you can decide together.

Living with this condition

Most people forget they are wearing a pessary once the right one is fitted. It should not stop you walking, swimming, exercising or working. Some people notice more discharge than before, which is common and usually manageable with regular checks. If you have a ring-type support, your clinician may say it can stay in during sex; other types are removed first. Always ask your own clinician what applies to you, and tell any new sexual partner only if you want to.

Lifestyle tips

• Build pelvic floor exercises into your daily routine, such as while waiting for the kettle to boil
• Avoid standing or lifting for very long stretches without a break
• Treat and manage a long-term cough, and consider stopping smoking if you smoke
• Keep bowels regular by drinking enough fluid and eating plenty of fruit, vegetables and fibre
• Aim for a healthy weight; even a small amount of weight loss can reduce pressure on the pelvic floor
• Ask for help at work if your job involves heavy lifting
• Go for your scheduled pessary reviews even if you feel fine

Diet and exercise

There is no special diet for prolapse, but eating well matters. Fibre, fruit, vegetables, wholegrains and enough water help prevent constipation and straining. Walking, swimming and gentle strength work are good for general health and pelvic support. High-impact exercise, heavy weights or repeated jumping can make symptoms worse for some people, so build up slowly and stop if you feel heaviness or discomfort. A pelvic health physiotherapist can teach you safe exercises and breathing that protect the pelvic floor.

Mental health and emotional wellbeing

Prolapse and bladder problems can affect confidence, body image, sleep, work and relationships, and it is very common to feel worried or embarrassed at first. These feelings are valid, and talking about them helps. Many people find that once symptoms are managed, their confidence returns. If low mood, anxiety or distress is affecting your daily life, tell your GP or nurse, or contact a mental health service or crisis line in your country. You deserve support without judgement.

Prevention

Not all prolapse can be prevented, because pregnancy, birth, genes and ageing all play a part. But you can lower the strain on your pelvic floor: do pelvic floor exercises regularly, avoid long-term constipation and heavy lifting, keep to a healthy weight, and get a lasting cough treated. If you are pregnant or have recently given birth, ask about pelvic floor physiotherapy.

Vaccines

There is no vaccine for prolapse. Keeping up with routine vaccines and treating chest infections promptly helps avoid long-lasting coughing, which strains the pelvic floor.

Screening programmes

There is no routine screening programme for prolapse. Instead, see your GP or practice nurse if you notice a bulge, heaviness or bladder or bowel changes. If you have a pessary, keep to the review schedule your clinic gives you, as these check-ups are how problems are caught early.

Complications

If left untreated

• Prolapse symptoms may gradually worsen, with more dragging, bulging or discomfort
• Bladder or bowel problems such as difficulty passing urine or emptying your bowels
• In rare cases, urine can be held back and not drain at all, which needs urgent care
• If a pessary is left in too long without a check, it can cause irritation, discharge, sores or, rarely, more serious ulceration
• Skin in the vaginal area can become raw or infected
• Reduced confidence, sleep and enjoyment of everyday life

Long-term outlook

The outlook is generally good. Many people use a pessary comfortably for years, and there are several options if one does not suit you. Prolapse rarely becomes dangerous, and most symptoms can be managed well with the right support, exercises and regular check-ups. Seeing your GP or nurse early gives you the widest range of choices.

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