A number of people whom I have supported to use a pessary have commented and/or emailed me afterwards to tell me how it has given them their life back. Fitting a pessary is one of the most rewarding aspects of my job!

The pessaries we use are usually made of soft silicone. They are placed within the vagina, and help support the vaginal walls and uterus (womb) in an improved position. Therefore relieving bothersome symptoms such as pressure, bulging and difficulty emptying bladders and bowels. They can be a safe, long term management option for vaginal prolapses.

Pessaries are becoming more widely used as an option to relieve symptoms of a vaginal prolapse. Many more specialist pelvic health physiotherapists are trained to assess suitability for pessaries and to fit pessaries for those who are suitable and who want to trial one.

Here at pelvic health physio, I mainly fit and encourage self managing pessaries - these are ones the person can insert and remove themself. For the majority of people their prolapse can be successfully supported with either a ring pessary or a cube pessary, however there are many different shapes and sizes on the market and quite simply sometimes it involves some trial and error to get the right one for the individual.

Women of all ages can benefit from a pessary, you are never too young or too old. If you have a prolapse that is bothersome, then it is usually a viable option.

Some people use them just during sport and exercise, and others use them daily. There is no set recipe with their use.

Most often we use them alongside other physiotherapy interventions such as optimising bladder and bowel health (addressing constipation quite often is a priority), improving pelvic floor muscle support systems, addressing breathing mechanics, guiding back to sport and exercise in a graded way (if required) and improving general strength, health and fitness.

What to expect at a pessary appointment:

NB prior to the appointment we will have already taken your medical history and details of your symptoms and how they are affecting you. We will have checked that you are suitable to trial a pessary. This will have been done at a previous appointment with ourselves, or with another health care professional that has referred you on to us

• The pessary fitting appointment is usually 45-60 minutes long

• Discussion around reasons for pessary use, and a check that there are no reasons not to use one (contraindications)

• An internal vaginal examination to assess pelvic floor strength, co-ordination and timing.

• Measurement of the prolapse and measurements for pessary size. These measurements may involve use of a ruler, and involves inserting 2 fingers into the vagina.

• Discuss which pessary would be suitable, and then the physio will insert the pessary deemed best

• You will then get changed have a walk around the room go outside and walk around the clinic, go and have a wee and do some squats! This is to check the pessary stays in place and that it feels comfortable.

• If the pessary is in a good position and comfortable, patients are shown how to insert and remove their pessary

• If the pessary is not sitting in a satisfactory position then your physio will trial a different size and in some cases a different type.

Afterwards it is important that you attend the clinic in 3-4 weeks time for us to check how you are using your pessary and to use a small speculum to check the health of the vaginal walls.

If you are self managing you r pessary independently at this point, and don’t require further physiotherapy appointments then you will need to attend every 6 months to 12 months for pessary checks, change of pessary when required and checks of your vaginal walls.

We are happy to field video calls and phone calls to discuss your individual needs. If you need signposting to someone more local to you, we will aim to do this for you just pop us an email info@pelvichealth-physio.com