What is a pessary and how does it help treat pelvic organ prolapse?

Charlotte Conlon is a Women’s Health Physiotherapist from Flow Physio Co Sutherland. Today she talks to us about using pessaries in the management of pelvic organ prolapse

Pelvic Organ Prolapse

Pelvic organ prolapse is when one or more of the pelvic organs (bladder, uterus and bowel) slip down into the vagina causing a bulge or a heavy dragging feeling. Prolapse happens due to damage of the support structures of the pelvic floor including muscles, fascia or ligaments.

What is a pessary?

A pessary is the leading conservative treatment for pelvic organ prolapse.

A pessary is a silicone device that it inserted into the vagina to help support a pelvic organ prolapse .  A pessary can manage symptoms of a prolapse, these symptoms include a feeling of heaviness or dragging around the vagina a bulging around the vagina and incomplete emptying of your bladder or bowel.

A pessary can be very useful to help you continue  to be physically active and participate in chosen activities which may typically worsen a prolapse. A pessary can be worn all the time or it can be worn just when demands are hight i.e.: when running or jumping. 

What kind of pessary will I use?

Every womens body and prolapse is different therefore the type and size of pessary will vary immensely from women to women. The type and size will depend on the type of prolapse, the symptoms it causes and your anatomy. The pessary has to be fitted correctly and it may take several tries to get the right one. After the first fitting, you will need to be reviewed in 2 weeks to have the pessary checked. Follow up is needed every 3 months as sometimes a different size or shape of pessary will have to be fitted, as things may improve or change over time. 

What’s it like having a pessary? 

If you have a pessary that is the right size and in the right position, you won’t be able to feel it and you’ll be able to do all your normal activities. A pessary that is to small can fall out but it cannot end up anywhere else in your body. A pessary with is to big may cause rubbing and irritation. 

Does the pessary cause any side effects?

Pessary side effects are very low-risk they and you should tell your physiotherapist immediately if you have any discomfort, increased vaginal discharge or if you have trouble urinating or opening your bowels. An oestrogen cream and taking the pessary out daily or weekly may be needed to help prevent some of these side effects. 

How long will it take to fit a pessary?

A pessary fitting appointment will take 60 minutes and will include a full prolapse assessment. Measurements will be recorded for a baseline and follow-up appointments will compare these measurements to monitor changes over time. We will use a sterile pessary fitting kit to ensure we find the correct size as this may take a few attempts, once the size is decided you will then purchase that size. 

 

2019 Guidelines for Physical Activity in Pregnancy - Flow Physio Co Sutherland - Women's Health Physio

The 2019 Canadian Guideline for Physical Activity in Pregnancy  provide guidance for pregnant women, obstetric care and exercise professionals on prenatal exercise.

The guidelines provide evidence based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, foetal and neonatal health. 

The Benefits of Being Active through Pregnancy

In the absence of contraindication, following these guidelines is associated with fewer newborn complications and maternal health benefits such as:

• Decreased risk of gestational diabetes and preecplamsia

• Less risk of Instrumented-assisted delivery; and

• Decreased risk urinary incontinence post birth

What is Recommended?

The guidelines make 4 strong recommendations and 2 weak recommendations:

1. All women without contraindications should be physically active throughout pregnancy (Strong recommendation, moderate-quality evidence)

2. Pregnant women should accumulate at least 150 of moderately intense physical activity each week to achieve clinically meaningful health benefits and reduction in pregnancy complications (Strong recommendation, moderate-quality evidence)

3. Physical activity should be accumulated over a minimum of 3 days per week, however being active everyday is encouraged (Strong recommendation, moderate-quality evidence)

4. Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits (Strong recommendation, high-quality evidence)

5. Pelvic floor muscle training may be performed on a daily basis to reduce the risk of urinary incontinence - instruction on proper technique is recommended (Weak recommendation, low-quality evidence)

6. Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position (Weak recommendation, very-low quality evidence)

Enhancing maternal health and reducing pregnancy complications

In conclusion prenatal exercise should be therefore considered the front line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health. 

What should you do?

You should check with your obstetric care provider or Women’s Health Physio to make sure you don’t have any contraindications to exercise and enjoy the wonderful benefits of being active through pregnancy.

Source:

• 2019 Canadian Guidelines for Physical Activity in Pregnancy