How Pelvic Floor Physiotherapists Use and Fit Pessaries for Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a condition where the pelvic organs, such as the bladder, uterus, or rectum, descend into or outside of the vaginal canal due to weakened pelvic support structures such as the ligaments, muscles, and fascia. This can lead to discomfort, urinary or bowel issues, and a feeling of heaviness in the pelvis. Pelvic floor physiotherapists can play a crucial role in managing POP, including the use and fitting of pessaries.
Understanding Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the pelvic floor muscles and connective tissues become too weak or damaged to support the pelvic organs. This can be due to various factors, including childbirth, aging, heavy lifting, chronic coughing, chronic constipation, and menopause. Symptoms of POP can include:
A feeling of pressure or fullness in the pelvic area
Urinary incontinence or difficulty urinating
Bowel issues, such as constipation or a feeling of incomplete evacuation
Pain or discomfort during intercourse
Visible bulging of tissue in the vaginal area
What is a Pessary?
A pessary is a medical device inserted into the vagina to support the pelvic organs and help manage symptoms of POP. Pessaries come in various shapes and sizes, and they can be made of silicone or other materials. They are a non-surgical option that can provide significant relief for many women.
The Role of Pelvic Floor Physiotherapists
Pelvic floor physiotherapists are trained to assess and manage POP, and they can assist in the fitting and use of pessaries. Here’s how they help:
1. Assessment and Diagnosis
The first step is a thorough assessment to determine the type and severity of the prolapse. This involves a physical examination and a discussion of symptoms and medical history. The physiotherapist will evaluate the strength and function of your pelvic floor muscles and identify the best management strategies.
2. Choosing the Right Pessary
There are different types of pessaries, such as ring, cube, and dish pessaries, each suited to different types of prolapse and individual needs. The physiotherapist will help you choose the right pessary based on your specific condition and lifestyle. Factors considered include the type of prolapse, severity, personal comfort, and ease of use.
3. Fitting the Pessary
Proper fitting of a pessary is crucial for its effectiveness and comfort. The physiotherapist will:
Insert the Pessary: The physiotherapist will insert the pessary into your vagina, ensuring it fits snugly without causing discomfort.
Check for Comfort and Effectiveness: You’ll be asked to move around, sit, stand, and even use the restroom to ensure the pessary stays in place and feels comfortable.
Teach You How to Remove and Reinsert It: For many women, learning how to manage the pessary independently is important. The physiotherapist will guide you on how to remove, clean, and reinsert the pessary as needed.
4. Pelvic Floor Muscle Training
In addition to fitting the pessary, the physiotherapist will provide exercises to strengthen the pelvic floor muscles. These exercises can help improve support for the pelvic organs and potentially reduce the severity of the prolapse over time. A personalized exercise program will be designed to fit your needs and abilities.
5. Ongoing Monitoring and Support
Regular follow-ups are essential to ensure the pessary continues to fit well and effectively manage your symptoms. The physiotherapist will monitor your progress, make any necessary adjustments, and address any concerns or complications that arise.
Benefits of Using a Pessary
Using a pessary offers several benefits for women with POP, including:
Non-Surgical Management: Pessaries provide a non-surgical option for managing POP, which can be particularly beneficial for women who are not ready or able to undergo surgery.
Symptom Relief: Pessaries can significantly reduce symptoms like pressure, incontinence, and discomfort.
Improved Quality of Life: By alleviating symptoms, pessaries can help improve daily functioning and quality of life.
Flexibility: Pessaries can be removed and reinserted as needed, allowing for flexibility in their use.
Taking the First Step
If you’re experiencing symptoms of pelvic organ prolapse, consulting a pelvic floor physiotherapist is an excellent first step. They can assess your condition, discuss treatment options, and help you determine if a pessary is right for you.
