Vaginal pessary for prolapse

This leaflet explains the following.

• What a pelvic organ prolapse is.

• What can cause a prolapse.

• The possible symptoms of a prolapse.

• What a vaginal pessary is.

• The benefits and the risks of having a pessary in place.

• The alternatives to pessaries.

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.

What is pelvic organ prolapse?

Prolapse is a term that applies to any organ in the body that has moved from its original position. In gynaecology we refer to this as the altered position of the uterus (womb) and / or the vaginal walls.

What causes a prolapse?

There are a number of reasons why you may develop a prolapse.

1. Childbirth and pregnancy can cause damage to the supportive structures within the pelvis.

2. The pelvic floor can weaken as we get older and hormone levels change at or after the menopause, alongside other genetic factors.

3. You are at higher risk of developing a prolapse if you:

   • are overweight;

   • carry out very heavy physical work;

   • smoke; or

   • suffer with chronic (long-term) chest conditions that cause you to cough.

   This is because of the extra strain these put on the muscles and ligaments of the pelvis.

What are the symptoms of a prolapse?

You may not have any symptoms of a prolapse. If this is the case, treatment or surgery is not always needed.

If you do have symptoms you may:

• feel a sensation of something coming down, a heaviness or a bulge in your vagina;

• find it difficult to empty your bladder and / or bowel, or you may leak urine (pee);

• feel a ‘dragging’ sensation in your vagina; or

• have difficulties or pain during sex.

How is a prolapse treated?

• You may be able to improve your symptoms by making lifestyle changes. These changes include losing weight or stopping smoking.

• Carry out pelvic floor muscle exercises, supervised by a specialist physiotherapist. We can refer you, if needed. Pelvic floor exercises can help to strengthen the muscles and ligaments in your pelvis. Depending on how big your prolapse is, this may help reduce your prolapse.

• We can use a vaginal pessary to help your symptoms.

• You may wish to consider surgery.

What is a vaginal pessary?

A vaginal pessary is a device inserted into the vagina that holds a prolapsed womb and / or vaginal wall in place. Pessaries can be made of silicone or vinyl.

You can use a vaginal pessary if you would prefer to avoid surgery, or to control your symptoms while you are waiting for surgery. We may suggest that you use a pessary if you want to have children or if surgery may not be a safe option, due to other health problems.

There are a variety of vaginal pessaries available. The two types of pessary that we use most often are ring and shelf pessaries.

• A ring pessary is round and comes in different sizes. You will need a vaginal examination to decide what size you will need.

• A shelf pessary gives extra support if a ring pessary does not stay in place. You will need a vaginal examination to decide what size you will need.

1. 
   Ring pessary. Source: Miss Farah Lone, Consultant Urogynaecologist; Royal Cornwall Hospital
2. 
   Shelf pessary. Source: Miss Farah Lone, Consultant Urogynaecologist; Royal Cornwall Hospital

How is a pessary fitted?

You will have your pessary fitted by a doctor or a specialist nurse in a gynaecology clinic.

• The doctor or nurse will talk to you about your symptoms, and will decide with you which type of pessary is best for you.

• You will have a vaginal examination, which will give an estimate of the size of pessary you need. It may take a few tries to get the right one.

• The doctor or nurse will place the pessary into your vagina and move it into place to sit behind your pelvic bone. It will take about 30 seconds to get it in and move it in to the right place.

• You may feel some discomfort when they insert it, but it should not be painful.

• After the first fitting, the doctor or nurse will ask you to walk around for 15 to 20 minutes. This is to make sure the pessary does not fall out and that you can pass urine (pee) with the pessary in place. A properly fitted pessary should not cause any pain; if it does we will need to change the size. We may also need to fit a different size if it falls out or you cannot pass urine with it in place.

• You can go home once you feel comfortable with your pessary. You will be able to carry on with your normal daily activities without any problems.

Will I have a follow-up appointment?

We will ask you to come for a follow-up appointment 6 months after we have fitted your pessary. At this appointment we will check that you are happy with the pessary and change it for a new one.

Can I wear the pessary during sex?

Please talk to your doctor or specialist nurse about this. You can have sex with a ring pessary but you cannot have sex with a shelf pessary.

If you find sex with a ring pessary to be uncomfortable, we can teach you to take it out before sex, and replace it yourself, if you would prefer. This is safe to do at home.

A pessary is not a form of contraception. Please continue to use your usual method of contraception.

What are the risks of having a pessary?

It is important you report any of the following symptoms to your GP or specialist nurse.

• Any difficulty passing urine (pee).

• Any change in the colour of your vaginal discharge.

• Any unpleasant smelling vaginal discharge.

• If your pessary falls out and you want to try another one.

• If you have any bleeding from your vagina. The pessary may be rubbing and causing grazing or an ulcer in your vagina. If this happens, we will have to remove your pessary for a while (we will tell you how long), to allow the grazing to heal. We may recommend using vaginal oestrogen cream or dissolvable pessaries during this time. This will thicken your vaginal tissues and stop them from becoming dry and thin. If needed, we will give you specific instruction about this.

How often does the pessary need changing?

Most pessaries need changing every 6 months, unless your doctor or nurse have told you otherwise.

• If you have a ring pessary your GP or practice nurse may change it.

• If you have a shelf pessary this needs to be changed at the hospital. We will arrange an appointment for you to come and have this done. We will check your vagina for grazes or any other problems, such as infection, before inserting a new pessary for you.

Before having a pessary fitted, it is important that you understand that you must agree to come to these regular appointments. If you are unable or unwilling to attend regularly, we will need to discuss and agree a different way to manage your prolapse. If you leave the pessary in for too long it can become difficult to remove. In some cases, we may need to remove it during an operation under anaesthetic. This can cause serious problems, such as infection or tissue damage.

Who do I contact if I have queries or concerns?

If you have any problems with your pessary or any queries or concerns, please contact the urogynaecology nurse specialists.

• Urogynaecology Nurse Specialists
  Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
  Telephone: 01843 235141

• Urogynaecology Nurse Specialists
  William Harvey Hospital (WHH), Ashford
  Telephone: 01233 651987

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

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• Patient Voice Team
  Telephone: 01227 868605
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