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Explained: Pelvic Organ Prolapse and Pessaries

Pelvic organ prolapse (POP) is the descent of 1 or more of the pelvic organs into the vagina. This can be recognised by a lowering of either the front (bladder) or back (rectum) walls of the vagina, and/or the uterus lowering downwards into the vagina.

The pelvic floor is made up of muscles, ligaments and connective tissue called fascia. The ligaments and connective tissue is very important for holding up the pelvic organs (bladder, rectum, uterus) while the muscles are very important in providing support from underneath.

POP can result from a stretch or tear to the fascia and/or muscles which can occur due to the added weight of the baby during pregnancy or from the birth itself.

The symptoms:

  • A bulge at the entrance of the vagina (usually at the end of the day)

  • Heaviness or a dragging feeling in the vaginally (usually worse at the end of the day or after exercise)

  • Difficulty emptying your bladder or bowels known as "incomplete emptying"

  • Painful intercourse

  • Low back ache

How is prolapse assessed?

Your treating physiotherapist will undertake an internal examination (with your consent) to indicate if you have a prolapse or not. We use specific skills to measure the grade of the prolapse (mild, moderate or severe). We will also assess your pelvic floor (tone, strength, coordination) that may be contributing to your prolapse symptoms.

Treatments Available

  • Pelvic Floor Muscle Training. Improving the tone, strength and coordination of these muscles.

  • Optimise breathing patterns and the abdominal wall, particularly during exercise and functional movement.

  • Optimise bowel and bladder health (reduce straining, how to empty your bladder effectively)

  • Exercise and lifestyle advice - what you can do and what you should minimise/avoid.

  • Pessaries - a 'brace for the vagina', to support the organ/s that descend down into the vagina which are contributing to your symptoms.

  • Talk to gynaecoglogists/colorectal surgeons regarding prolapse management/post-op advice.

What is a Pessary?

A vaginal pessary is a device used to treat pelvic organ prolapse (POP). It is made of medical grade silicon and is inserted into the vagina to hold the prolapsed organ(s) in place. We explain to patients that is it like a 'brace for the vagina', to support the organ that is descending down into the vagina, and to reduce the symptoms they might be experiencing such as heaviness, dragging, and/or incontinence. It is designed to substitute the support that was previously provided by the muscles and fascia, and thereby relieve the symptoms of POP.

Types of pessaries:

Pessaries come in many different shapes and sizes. The most common forms of pessary we use in our clinic include:

1. Ring Pessary

This pessary is the most basic form of pessary and the one most commonly used. It is easy to insert and remove but is also the most easy to fall out. Some women can achieve intercourse with this in place, whilst other can learn to insert and remove this pessary themselves.

2. Cube Pessary

This pessary creates a suction seal to both the top of the vagina as well as the vaginal walls. It is reasonably easy to insert and remove, and is only suitable for patients who are comfortable inserting and removing their pessary themselves on a nightly basis.

3. The Gellhorn Pessary

This pessary is often used when the prolapse is more severe, or if a ring pessary has been unsuccessful (has fallen out). It has the added benefit of creating a vacuum suction to the top of the vagina to help hold it in place. The Gellhorn also needs to be removed frequently

Here are some of the pessaries we fit at Body Align Physio.

There is 'no one size fits all' so it is incredibly important to discuss with your treating women's health physiotherapist and find the best pessary for you! Contact us at Body Align Physio on (02) 44542309 for more information.

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