Pessaries

What you should know about pessaries:
Once in place, you should not feel a pessary (if it is the appropriate size, type, inserted properly).
People often feel immediate changes in symptoms when it is in.
Pessaries can help people with most grades of prolapse.
Pessaries may complement your current pelvic physiotherapy programming.
You can remove and insert the pessary yourself.
You can use a pessary sometimes OR all the time - depending on your goals.
You can wear certain types of pessaries during sex (otherwise they are removed).
You can wear a pessary during your period (for most types).
In some cases, pessaries can fully resolve symptoms and diminish the need for surgery.

What we do at a pessary fitting appointment with our Pelvic Health Physiotherapists:
We will always answer any questions, at any time, that you may have. If at any point this is not aligning with your goals, we can defer the use of a pessary for your treatment

1) Health review: Go over current health status and health history and review current symptoms and goals. 

2) Pessary review: Review the anatomy, benefits and uses of pessaries and rule out any reasons a pessary may not be appropriate. We will also review any other treatments or strategies that may support the use of your pessaries. 

3)   Pelvic health examination:  We will discuss what a pelvic floor examination would entail and if you are comfortable, we will do a thorough pelvic examination to assess your skin and muscles; how movement and pressure affect the pelvic floor; the type of prolapse you have; and take measurements to select the appropriate pessary. We take precautions to ensure this is not painful. 

4) Pessary fitting: if you would like to proceed, based on the assessment, we do a trial of a pessary appropriate for you. We have you test it out by standing, walking, squatting, coughing, voiding, and doing any other activities that cause your symptoms. We then make any adjustments to the pessary based on how it feels for you.

5) Pessary use: We will then chat about pessary use: insertion, removal, cleaning, and ensure that you have practiced and are comfortable doing so before taking one home. We also send home handouts that review everything we go over in this appointment. 

6) Order pessary: We then order the pessary from our supplier which can take 2-7 business days. 

7) Follow up:  We will schedule a follow up with your pelvic physiotherapist within 1 month of utilizing your pessary. We would like you to follow up with your family doctor/ gynaecologist within 3 months and then again at 6 months and 1 year after utilizing a pessary. 

Other considerations:
We will need a family doctor/ gynaecologist referral for a pessary with a clearance of a normal internal exam within the last year to dispense a pessary. Some people will bring it with them to their initial appointment if their care provider has already referred them. If you are self referring, we can request this from your care provider after our assessment.