Vaginal pessaries for pelvic organ prolapse (POP)

You have been given this leaflet because you have a pessary for a POP.

What is prolapse?

Prolapse is a condition where the womb or vaginal walls drop down from their normal position. You may feel that ‘something is coming down’ in the pelvis or have symptoms of a lump or bulge in the vagina. This lump might even come out of the vagina.

What is a vaginal pessary?

A vaginal pessary is a plastic or silicone device that sits inside the vagina. It helps support the walls of the vagina and should reduce the symptoms of the POP. The pessary should be comfortable and help improve your quality of life. Two out of three women who use a vaginal pessary long term find it an acceptable option for management of their prolapse symptoms.

What happens next?

After you have been fitted for a pessary, make sure you can empty your bladder before you leave hospital. Have a drink and a walk around the hospital if required.

A pessary will normally be changed every four to six months. However, this may be up to 12 months in specific circumstances (for example, restrictions to face-to-face appointments due to pandemics). It has been shown that it is perfectly safe for the pessary to be in place for up to 12 months as long as you do not experience side effects such as vaginal bleeding, discomfort or discharge. If you experience any problems before your next pessary appointment, please contact us.

Selecting the correct size and type of pessary is a process of trial and error. If the pessary falls out, please do not be alarmed. We may need to try another pessary. Finding the correct pessary can sometimes take two or three visits.

A new pessary is required when the pessary is showing signs of wear (such as cracks or splits), smells, or if it is not controlling the symptoms of pelvic organ prolapse sufficiently and in accordance with specific manufacturer’s instructions.

At each visit, the control of symptoms and the fit of the pessary should be assessed. The pessary should be removed, and the vaginal walls, and if present, the cervix, inspected using a speculum. The same pessary may be washed and replaced if it does not show signs of wear, or a new one inserted, which may be the same type and size, or an alternative if the previous one is not completely satisfactory.

What should I look out for?

Please contact the department if you experience:

• vaginal bleeding (not associated with a menstrual bleed or a pessary change)
• pain or discomfort in the vagina
• offensive discharge (an increase in discharge is normal with a pessary)

What happens if I have problems with my pessary?

You can contact the physiotherapist, nurse or consultant’s secretary by phone if you experience problems. Please leave a message on any answer machine, but note that you might not get a response immediately.

• specialist nurse 01223 349239
• physiotherapist 01223 217422
• consultant’s secretary 01223 586740

If you have urgent concerns, you can contact your GP, or call Daphne Ward on 01223 217636. The ward opening hours are: Monday to Friday 08:00 (8am) to 20:00 (8pm) and Saturday and Sunday 08:30 to 14:00 (2pm). You may find it useful to note the type____________ and size____________ of your pessary.

Further information

• Information for patients (opens in a new tab) – British Society of Urogynaecology 020 7772 6211
• Your pelvic floor (opens in a new tab) – International Urogynecology Association (IUGA) +1 952 683 9037
• Vaginal prolapse infographic (opens in a new tab) – Pelvic, Obstetric and Gynaecological Physiotherapy

CUH cannot accept responsibility for information provided by other organisations.

References

BSUG Guidance on management of Uro-Gynaecological Conditions and Vaginal Pessary use during the Covid 19 Pandemic, April 2020

Guideline, NICE 2019. Urinary incontinence and pelvic organ prolapse in women: management.

de Albuquerque Coelho SC, de Castro EB, Juliato CR. Female pelvic organ prolapse using pessaries: systematic review. International Uro-Gynecology journal. 2016 Dec;27(12):1797-803.

Lamers BH, Broekman BM, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. International Uro-Gynecology journal. 2011 Jun 1;22(6):637.