What is a pessary?
A pessary is a silicone device that can be inserted into the vagina to provide mechanical support to either your prolapsed pelvic organs (if you have pelvic organ prolapse) or to your urethra if you have stress urinary incontinence (leakage of urine with laughing, coughing and sneezing). Pessaries come in many different shapes and sizes, and it is likely that your urogynecologist can find one that would fit you well and address your problems.
Using a pessary is an alternative to surgery and is appropriate if you would like to delay or avoid having an operation for your pelvic floor disorder. Some women, for example, wear pessaries until they are finished having children. Even if you use a pessary for relief of your symptoms for a period of time, you can still have surgery in the future.
How can I initiate pessary therapy for my pelvic floor disorder?
If you want to try a pessary, your Northwestern Medicine urogynecologist will perform an evaluation in the office to determine the size and type of pessary you need based on your symptoms (prolapse or urinary incontinence) and physical exam. You will be allowed to go home wearing your pessary the same day and asked to follow up with one of the urogynecologists or one of our advanced practice nurses in one to three weeks. Sometimes if the pessary is too small, it may fall out during a bowel movement; if it is too large, you may feel pressure or discomfort.
At your return visit, if the pessary is successfully controlling your symptoms and you like it, we will either teach you to remove and reinsert it yourself or you can follow up with one of our advanced practice nurses every three to four months. Sometimes patients need to try several different pessaries to find the right size. You can remain sexually active and still use a pessary in most cases.
How successful is pessary therapy?
Most women with pelvic organ prolapse and or urinary incontinence can be successfully fitted with a pessary. The goal of a successful pessary fitting is to adequately control symptoms related to pelvic organ prolapse (the sensation of a bulge in the vagina) and urinary incontinence (leaking urine with activities such as coughing, laughing, running, etc.) without discomfort. It is important to remember that while pessary therapy is effective at managing the symptoms of prolapse and of incontinence, it does not reverse the process of these pelvic floor disorders. Thus, once a pessary is removed, women will have recurrence of their pelvic floor symptoms.
Are there risks or side effects associated with a pessary?
Using a pessary for pelvic organ prolapse or stress urinary incontinence is very safe. There are no risks associated with using a pessary as long as you follow up with your urogynecologist or advanced practice nurse as recommended. Sometimes if the pessary is worn for a long period of time, the vagina may develop a small pressure sore. If this happens, your urogynecologist may ask you to remove it for two to four weeks and/or use vaginal estrogen. Some women also have an increased amount of vaginal discharge, which is normal.