Prolapse and Pessary Fitting
Pelvic organ prolapse is a common condition that can affect women at different stages of life. It occurs when one or more of the pelvic organs, such as the bladder, womb or bowel, descend towards the vaginal opening because the supporting muscles and tissues have weakened.
Prolapse can cause physical discomfort, affect bladder or bowel function and influence confidence, exercise and everyday activities. However, there are treatment options available, and you do not have to simply put up with symptoms.
At West Wales Women’s Wellbeing, our Consultant Gynaecologist can assess your symptoms, discuss the options available and help you understand whether a vaginal pessary may be suitable for you.
What are the symptoms of pelvic organ prolapse?
Prolapse symptoms vary from person to person. Some women notice a visible or noticeable bulge, while others experience pressure or changes in bladder or bowel function.
You may benefit from an assessment if you experience:
- A feeling of heaviness or pressure in the vagina or pelvis.
- A vaginal bulge that you can feel or see, particularly when standing, lifting or exercising.
- Bladder symptoms, such as difficulty emptying your bladder, needing to urinate more frequently or a sensation that your bladder has not emptied fully.
- Bowel symptoms, including difficulty emptying your bowels or a feeling of incomplete emptying.
- Discomfort during exercise or everyday activities, particularly when lifting, walking or standing for long periods.
- Discomfort during sexual activity or concerns about how prolapse is affecting your intimate life.
Symptoms may become more noticeable as the day progresses or during activities that place pressure on the pelvic floor.
What causes prolapse?
The pelvic floor muscles and supporting tissues help hold the pelvic organs in their usual position. When these structures weaken or become stretched, prolapse can develop.
Factors that may contribute include:
- Pregnancy and childbirth, particularly vaginal birth.
- Ageing and changes associated with the menopause.
- Long-term constipation or repeated straining.
- Persistent coughing.
- Regular heavy lifting or activities that place increased pressure on the pelvic floor.
- Previous pelvic surgery.
- A family history of prolapse or inherited differences in connective tissue strength.
Prolapse is not your fault, and symptoms can develop even when you have taken steps to look after your pelvic health.
How can a pessary help?
A vaginal pessary is a removable medical device placed inside the vagina to support the pelvic organs. It can help reduce the sensation of heaviness or bulging and may improve symptoms associated with prolapse.
Pessaries come in different shapes and sizes. The most suitable type depends on the nature of your prolapse, your symptoms, your anatomy and your preferences.
A pessary may be an option if you:
- Want to manage your symptoms without surgery.
- Prefer a non-surgical treatment.
- Want support while remaining active and continuing everyday activities.
- Are considering surgery but would like to explore other options first.
- Are not suitable for surgery or would prefer to avoid it.
A pessary does not permanently repair the supporting tissues, but it can provide effective symptom relief for many women. It is not the right option for everyone, so an individual assessment is important.
Is a pessary right for me?
A pessary can be a useful option, but treatment should reflect your symptoms, the type of prolapse and your personal preferences.
Some women benefit from pelvic floor muscle training, particularly when symptoms are mild. Others may prefer to try a pessary, while some may need further assessment or referral for specialist treatment.
You do not need to decide on a treatment before your appointment. Your consultant can help you understand the options and make an informed decision about your care.
What happens during a prolapse consultation?
Your consultation provides an opportunity to discuss your symptoms, how they affect your life and what you would like to achieve from treatment.
Discussing your symptoms
Your consultant will ask about the symptoms you are experiencing, when they occur and whether you have noticed changes in your bladder, bowel function or sexual comfort. Your medical history, previous pregnancies and childbirth, and any previous pelvic surgery may also be relevant.
Assessment and examination
If appropriate and with your consent, a pelvic examination may be recommended to assess the type and extent of prolapse. Your consultant will explain the examination beforehand, answer your questions and respect your preferences throughout.
Exploring your options
Depending on your symptoms and examination findings, options may include pelvic floor muscle training, lifestyle measures, a vaginal pessary or referral to discuss surgical treatment. Your consultant will explain which options may be appropriate for you.
What happens during pessary fitting?
If a pessary is suitable, your consultant will explain the fitting process and discuss the available options with you.
Choosing the right pessary
The type and size are selected according to your prolapse and individual needs. Sometimes more than one size or type needs to be tried to find a comfortable and effective fit.
Fitting the pessary
The pessary is gently inserted into the vagina. You may experience some pressure or discomfort, but you should tell your consultant if you experience significant pain.
Checking the fit
You may be asked to stand, walk, cough or bear down gently to check that the pessary stays in place and provides support. Your comfort and ability to carry out everyday activities are important considerations.
Aftercare and follow-up
You will receive advice about caring for your pessary, recognising possible problems and arranging follow-up. Depending on the type of pessary and your circumstances, it may need to be removed and cleaned at regular intervals. Some women can manage this themselves, while others need help from a healthcare professional.
A follow-up appointment may be needed to check that the pessary remains comfortable and is helping your symptoms.
Book a prolapse consultation
If you are experiencing vaginal pressure, a bulge, bladder or bowel symptoms, or other concerns that may be related to prolapse, West Wales Women’s Wellbeing can help you explore the next steps.
A specialist consultation provides an opportunity to discuss your symptoms, understand the treatment options available and consider whether pessary fitting may be suitable for you.