Gynaecology - Vaginal pessaries for Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Pelvic organs prolapse happens when the muscles and tissues supporting the pelvic organs (uterus, bladder and rectum) become weak. This allows one or more of the pelvic organs to drop from their natural position into or out of the vagina.

Prolapse is very common. Mild prolapse often causes no symptoms and treatment is not always necessary. However, prolapse can affect quality of life by causing symptoms such as discomfort or a feeling of heaviness. It can cause bladder and bowel problems and sexual activity may also be affected.

Prolapse can be reduced with various lifestyle interventions, including weight loss, exercise and avoiding constipation as well as avoidance of activities that may make your prolapse worse such as heavy lifting.

What are the treatment options for a Pelvic Organ Prolapse?

There are 3 options available to treat a Pelvic Organ Prolapse.
1.    Physiotherapy
2.    Pessary
3.    Surgery

What is a Vaginal Pessary?

A vaginal pessary is a device which can be inserted in the vagina to control symptoms that a prolapse may cause. It is made up latex, silicone or vinyl.

How does vaginal pessary work?

A vaginal pessary is placed in the vagina. It will stretch its walls and hold the soft tissue up so as to make you comfortable. It prevents the uterus or the vaginal walls from bulging through the vagina.

Occasionally for patients with very weak pelvic floor muscles, the pessaries may not stay in place. Your doctor will discuss this with you.

Will a pessary be the right option for me?

Insertion of a Pessary may be the option for you if;
●    You wish to have more children
●    You do not wish to have surgery
●    You are medically unsuitable for surgery
●    A temporary solution until surgery

What types of Pessaries are available?

There are many different pessaries available; however the types we use are Ring, POPY, Shelf and Gellhorn pessaries.

Ring Pessary

These are a round ring and are made from vinyl and are usually the first type of pessary tried. They are inserted to move the prolapse upwards back into the vagina and alleviate the symptoms associated with a prolapse. A ring pessary can be used by women wishing to continue sexual relations. They can be removed and reinserted by the patient if they wish.

Shelf and POPY Pessary

These are flat and oval in shape with a stem on the outer rim, made from silicone. They are rigid but are easily tolerated by the patient. These pessaries are suited to women who are no longer sexually active.

Gellhorn Pessary

These are circular with a stem similar to the Shelf pessary. They are made from silicone like the Shelf pessary but are less rigid and are also easily tolerated by the patient.

How is the Pessary inserted?

The pessary will be inserted by a doctor or nurse trained in the procedure of pessary insertion. The procedure will be explained prior to insertion and any questions/queries you may have will be answered prior.

A vaginal examination will be performed, using a speculum to see the cervix and the vagina walls. An internal examination will be performed to assess the type and size of pessary needed for insertion.

The pessary will be inserted and positioned, using water based lubricant or hormonal cream.

The fitting of the pessary is not based on an exact measurement and it can take several tries of different sizes until the correct fit is found.

What happens after I have had the pessary fitted?

You will be advised to go to the toilet, to make sure it doesn’t prevent you from passing urine. If the pessary falls out or is uncomfortable, it will be replaced with a larger or smaller one accordingly.

What are the risks associated with having a Pessary?

There are some side effects with having a Pessary, these include;
●    Discomfort or pain during insertion and removal of the pessary in the vagina
●    Increase in vaginal discharge
●    Vaginal bleeding or soreness due to the pessary rubbing the neck of the cervix. You should inform tour doctor if you have any bleeding
●    Urinary incontinence following insertion of the pessary as the position of the bladder can be moved during pessary insertion
●    The pessary may fall out. If this occurs contact the Gynaecology secretary to arrange an appointment for reinsertion. If the pessary falls out and you are unable to continue without the pessary, contact the Gynaecology Assessment Unit (GAU) for further care

Do I need to have the Pessary changed?

Patients using the ring pessary are followed up by their GP.

Patients with the Gellhorn, POPY and Shelf pessary are followed up in the hospital. The pessary will require replacing and assessing every 4 to 6 months to check it is working properly for you.

You will be given regular appointments to ensure the pessary is changed on time.

References

The Royal College of Nursing (2016) Genital Examination in Women

The Royal College of Obstetricians and Gynaecologists (2018) Menopause and Women’s health in later life

The Royal College of Obstetricians and Gynaecologists (2013) Pelvic organ prolapse

Important Telephone Numbers

Gynaecology secretary - 0161 627 8159 or 0161 656 1566

Gynaecology Assessment Unit - 0161 627 5536 or 0161 627 8855

Suggestions, Concerns and Complaints

For general enquiries please contact the Patient Advice and Liaison Service (PALS) – 0161 778 5665