Pelvic Organ Prolapse
Pelvic organ prolapse (POP) occurs when the uterus, bladder, urethra, gastrointestinal tract and/or rectum prolapse through the vaginal walls. People can also develop rectal prolapse, which is when the rectum, or part of the rectum, drops down or slides out of the anus. Weakness in fascia and pelvic floor muscles are two of the primary contributors in the development of POP. Risk factors, such as obesity and vaginal delivery, can cause weakness and damage to the pelvic floor muscles and fascia, thereby resulting in herniation of the organs.
Prolapses are graded on a scale of I – IV, with Grade IV being completely out of the vagina. Around 50% of women can develop pelvic organ prolapse, and 20% will undergo reconstruction surgery for POP. After surgery there is a 30% recurrence rate, requiring a second procedure. Pelvic Floor physical therapy improves pelvic floor muscle function and reduces POP symptoms. Pelvic Floor physical therapists can assess your need for a pessary, which is discussed below.
Symptoms of POP can include:
- Feelings of heaviness or bulging in the vagina
- Urine and/or fecal leaking (incontinence)
- Abnormal bowel and bladder emptying
- Bladder and bowel urgency, frequency
- Nocturia (nighttime urination)
- Frequent bladder infections
- Pelvic pain
- Painful sex
Causes of POP can be:
- Genetics
- Obesity
- Menopause
- Childbirth, with vaginal deliveries causing higher risk
- Age-related pelvic floor and girdle changes
- Previous Hysterectomy
What is a pessary?
A pessary is a prescribed removable device composed of soft medical grade silicone which is fit specifically for your anatomy. There are many different shapes and sizes available.
Why are pessaries used?
Pessaries are used as a conservative nonsurgical option for the treatment of pelvic organ prolapse and/or stress urinary incontinence. They can be very helpful in the post partum stage to support connective tissue and ligamentous healing. They are also good in the menopausal stage as an alternative to surgery. They work great for active women who just need support for running, lifting or other high level activities.
How is a pessary fitting performed?
A pessary fitting is performed with one of our certified practitioners, who are physical therapists. We will first decide the type of pessary to use, which is based on your history and our physical examination. They will fit you with a pessary and have you perform a lot of different functions/movements to determine that it is a good fit. You should not feel the pessary once it is fitted correctly, and we don’t want you to leave if it does not feel like it fits well. Many patients will be able to put in and take out the pessary on their own! We will take the time to educate you in how to do this, how to clean the pessary and how to know that it is in correctly.
If you cannot or do not want to manage the pessary, we will follow-up every 3 months to clean the pessary and ensure the tissue is healthy. Complications are rare, but it is important for these follow up visits to make sure none arise.
Risks
Risks associated with pessary use are rare and easily managed. Common side effects include vaginal discharge, odor and spotting. If spotting occurs, you should notify our office as this may be a sign of an erosion. An erosion occurs when the pessary rubs against the inside walls of the vagina. In this case, the pessary is typically left out to allow the erosion to heal. If erosions occur repeatedly, you may need a different size pessary or a pessary may not be a good option.