What is Prolapse?
Vaginal prolapse occurs when one or more pelvic organs begin to descend into the vagina, a condition clinically referred to as Pelvic Organ Prolapse (POP).
The specific type of POP is identified by which wall or organ has descended:
- Anterior Wall POP (Cystocele): This occurs when the bladder moves downward.
- Posterior Wall POP (Rectocele): This arises when the bowel shifts downwards.
- Apical POP (Uterine, Cervical, or Cuff Prolapse): This type happens when the cervix, or the cuff if you have undergone a hysterectomy, descends into the vagina.
Prolapse commonly presents with symptoms like a feeling of heaviness, bulging, or the sensation of "something there" between the legs. It may also cause low back or pelvic pain, as well as dysfunction in associated organs, leading to issues such as leakage or difficulty in bowel movements.
Image sourced from: www.weekswellness.com/blog/can-pelvic-floor-physical-therapy-help-my-prolapse
The Prolapse Pessary
The prolapse pessary is a silicone device designed to be worn intravaginally. Its primary function is to support the descending pelvic wall, effectively lifting and stabilising the pelvic organs back into their proper position.
An effective pessary will alleviate associated organ dysfunctions, such as leakage and bowel emptying issues, while also minimising symptoms like heaviness or bulging. They may also prevent further descent of the prolapse.
Pessaries must always be fitted by qualified healthcare professionals. General practitioners, gynaecologists, pelvic health physiotherapists, and some Continence Nurses can all receive specialised training for this procedure.
There is a diverse range of pessaries available in order to achieve an effective fitting. The Sayco Profem collection depicted in this image shows some of the common pessaries we use. While we often achieve the correct fit on the first attempt, it may sometimes require trying out several shapes and sizes. In some cases, there might not be a single ideal option, and surgical alternatives can be considered if necessary.
How Do I Use My Pessary?
There isn't a one-size-fits-all answer to this question. Some client's prefer their pessary to be managed by their clinician. In this case, they attend regular check-ups—typically 2 to 4 times a year—where the clinician removes, cleans, and replaces the device. During these visits, the clinician also conducts an examination to ensure the pessary is comfortably tolerated and that there are no adverse reactions.
In many cases, I teach my clients to self-remove and replace their pessary. This approach promotes self-management and reduces the need for frequent reviews. However, an annual check-up is still required to assess tolerance and identify any potential adverse reactions. Some clients prefer to use their pessary for specific activities, such as exercising or during periods of illness where there is a lot of coughing. Others may choose to leave it in place and self-remove it for cleaning and replacement twice a week.
Additionally, it’s important to consider that while some pessaries can remain in place during intercourse, others cannot. Factors such as sexual activity will influence the type of pessary that is most suitable for you.
Surgery or Pessary?
Choosing between treatment options often comes down to personal preference. While some individuals may find managing a vaginal pessary unappealing, others are eager to avoid surgery at all costs. It's important to note that even advanced cases of prolapse can respond positively to a pessary, regardless of their severity. However, there are times when a satisfactory pessary fit just isn't possible. In such cases, you have the option to either leave the condition untreated or consult with a specialist for further advice.
Want to Know More? Book a FREE Phone Consultation
Schedule a free, no-obligation phone consultation with Anna today! This is your opportunity to ask any questions you may have about your condition or diagnosis, learn how physiotherapy can assist you, explore what to expect during an assessment, or discuss potential treatment plans. Feel free to inquire about anything on your mind! A scheduled consultation lasts up to 15 minutes.
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