What is Pessary Fitting?
Pelvic organ prolapse occurs when the bladder, uterus, rectum, or vaginal vault shifts downward due to weakened pelvic floor support structures. This can create symptoms such as heaviness, pressure, bulging, urinary leakage, or difficulty emptying the bladder or bowels.
A pessary is a removable silicone device placed in the vagina to support pelvic organs and reduce your symptoms. It can provide immediate relief and help people return to daily activity and exercise with greater comfort.
Pessary use often works best alongside pelvic health pt that focuses on pelvic floor muscle coordination, strength, posture, and abdominal pressure management. Our pessary fitting service helps determine the right shape and size so the device supports both symptom relief and long term rehabilitation.
Pelvic health therapy plays a crucial role in supporting individuals experiencing a variety of pelvic health conditions, through a variety of treatment methods including pessary fitting. This is utilized with our patients who are experiencing pelvic organ prolapse (or POP). POP occurs when the pelvic organs (bladder, uterus, rectum, or vaginal vault if the uterus is removed) shift in a downward or outward direction leading to protrusion into the vaginal canal.
Prolapse typically occurs due to weakening of the connective tissues and ligament structures supporting the vaginal wall as well as the musculature of the pelvic floor. This can lead to symptoms of vaginal or pelvic heaviness, bulging, pressure, and discomfort that may worsen with activities 'on your feet' - think picking up your little one throughout the day or trying to go for a run.
POP can also be associated with other symptoms such as low back pain, pain with sex, and difficulty fully emptying your bladder or bowels. Further, weakening of the connective tissues supporting the urethra can lead to stress-based urinary leakage with activities like coughing, sneezing, or exercising. If you're interested in learning more about the ins and outs of what POP is and why it may happen, check out our
blog post here!
In addition to the variety of treatment methods we incorporate at pelvic health therapy to support your symptoms (*think pelvic floor and kinetic chain strengthening, posture mindfulness, breath and pressure mechanics with daily activity), there is another tool we can offer to assist with your symptoms...a pessary! What is a pessary? Let's dive deeper.
What is a pessary and how could it help me?
A pessary is a small, removable silicone device inserted into the vagina to provide support for the pelvic organs. Pessaries come in a variety of shapes and sizes to create a custom fit for each individual and works in conjunction with a comprehensive pelvic health therapy plan of care to improve your outcomes.
Common ways a pessary may help
- Symptom relief- A pessary can provide immediate relief for POP symptoms by supporting the tissues and lifting the bladder, uterus, or rectum to relieve symptoms of heaviness or bulging, and may help improve bowel or bladder emptying as the organs are in a more optimal resting position. A pessary can also help create a 'backstop' at the urethra to assist with urinary leakage. This relief may help with return to daily activity and exercise which may have felt symptom-limited prior to a pessary.
- Adding to pelvic floor rehabilitation- Pelvic health therapy commonly aims to improve the coordination, mobility, and strength of the pelvic floor muscles. A pessary can help lift the intravaginal tissues 'up' and reduce the load on the pelvic floor muscles and surrounding ligamentous tissues. This may improve the supportive ability of your pelvic floor muscles during daily activity and exercise.
- Helping to support movement patterns and lifestyle changes- Pelvic health therapy should include a holistic approach, including assessment of the kinetic chain, lifestyle management, and how looking at the 'big picture' is impactful for supporting POP and stress leakage symptoms. This may include addressing posture and ergonomics during daily activities such as lifting and squatting, breath mechanics for improved pressure management, and full-body strengthening. A pessary can act as a supportive tool during these adjustments, allowing you to transition to these habits with more confidence.
- Conservative care- Individuals may be deciding whether surgery for POP or stress-based leakage is the best fit for them; in the meantime, a pessary may offer a conservative management option for symptom relief and may be a great fit in lieu of surgery
Curious about a pessary fitting? Here's what's helpful to know:
- There are multiple styles and sizes - at Pelvic Pride, we offer cube & ring pessaries
- Pessaries are not a 'one size fits all'.
- It may take a few attempts to find the right size of pessary during a fitting appointment.
- Pessaries should be fit by a pessary-fitting-specialized healthcare provider like pelvic floor pt
- Wearing a pessary will require a few visits to make necessary adjustments and yearly follow up to monitor continued proper fit
- Success with a pessary can be supported with a pelvic floor therapy plan of care to address all components of prolapse symptoms, including pelvic floor muscle tension or weakness, lumbar spine & hip strength training, posture support, and pressure management
What to expect at a pessary fitting at Pelvic Pride
During your fitting, our pessary-fitting pelvic floor pt will complete an evaluation to learn about your current symptoms and concerns, review your medical history, and discuss your goals
for pessary use. During the appointment, you can expect:
- An external and internal pelvic floor muscle evaluation to assess the current status of your pelvic floor tissues including vulvar-vaginal tissue health, degree and type of prolapse, as well as muscle coordination and strength
- Fitting trials with the recommended pessary shape and size to find the best fit and comfort for you (this can include incorporating specific movements such as squatting, walking, and jumping)
- Review of pessary care, wear schedule, removal technique, and follow-up care recommendations
A pessary may benefit many during their pelvic health journey, offering relief from symptoms of POP and stress-based leakage when combined with a pelvic health therapy plan of care to help optimize your return to and comfort with daily activity and exercise. If you're experiencing vaginal pressure or heaviness, urinary leakage, difficulty emptying bowel/bladder, or any other symptoms of prolapse, we recommend speaking with a pelvic health therapist to determine if a pessary may be a helpful fit for you!
Looking for pelvic floor pt who fits pessaries in Maryland?
At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients struggling with pelvic floor issues, so you are in the right place! Dr. Marlena is our resident pessary expert and is happy to help fit you for a pessary for symptom reduction and progress towards your goals.
We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD (Pessary fittings currently offered in Federal Hill only). Fill out our
contact form& our Patient Care Specialist will reach out to you ASAP!
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