Treatment: Pessary insertion

What is pessary insertion?

Pessary insertion is a non-surgical treatment that’s used to treat pelvic organ prolapse. Pessaries are soft, flexible devices made out of rubber or plastic. They come in a range of sizes and types and are fitted by a gynaecologist.

What do pessaries do?

Pelvic organ prolapse is when the bladder, uterus, vagina, bowel and/or rectum, move down from their natural position and bulge into the vagina or protrude outside the vagina. This is a fairly common problem and often develops with age or as a result of childbirth.

A pessary works to support the walls of the vagina and keep your organs in place. It’s often used as a first line of treatment for women who want to avoid surgery or to treat prolapse in cases when surgery carries high risk.

What does pessary insertion involve?

Pessaries come in different shapes and sizes so need to be fitted by a gynaecologist during a vaginal examination. Although your consultant will be able to suggest a size and type of pessary, you may need to try a few different ones to figure out which works best for you.

A pessary that’s too small can fall out when you pass urine or have a bowel movement, while a pessary that’s too large can apply too much pressure and feel uncomfortable. It’s very normal to try two or three pessaries before finding a good fit.

Depending on which type of pessary you have, you may be able to insert and remove it yourself, or you may require the help of your gynaecologist.

If your pessary can be removed and reinserted at home, your gynaecologist will walk you through how to do this at your fitting consultation. This type of pessary should be removed, cleaned and replaced regularly and you should have a follow-up visit with your consultant gynaecologist every six to 12 months.

If you cannot remove your pessary by yourself you should arrange follow-up appointments with your consultant every two to three months.

How to insert and remove a pessary yourself:

The steps to insert a pessary are as follows:

1. Wash your hands and the pessary well with soap and warm water. Rinse and dry the device thoroughly.
2. Lie down with your knees bent or sit on the edge of a chair.
3. Fold the pessary in half and gently insert it into your vagina pushing it as far back as you can.
4. Let go of the ring so that it opens up into its normal shape.
5. Use your index finger to make sure the rim is behind your public bone.

To remove your pessary, follow these steps:

1. Wash your hands well with soap and warm water.
2. Lie down with your knees bent or sit on the edge of a chair.
3. Insert your index finger into your vagina and find the rim of the pessary.
4. Hook your finger under the rim and bear down as if you were having a bowel movement.
5. Pull the pessary down and out.

Side effects of using a pessary

An increase in white discharge is common with pessary use and is nothing to worry about. Other side effects of pessaries can include:

• Foul-smelling vaginal discharge
• Irritation and sores inside the vagina, with pink or bloody discharge
• Stress incontinence
• A urinary tract infection
• Ulceration and excoriation of the vaginal walls

If you’re experiencing any side effects from having a pessary, your consultant will be able to provide guidance. These issues are usually caused by a pessary being too big or too small, so switching to a different size or type often resolves the problem or because the pessary has moved and dislodged inside your vagina.