Approximately 50% of women will experience a prolapse at some stage in their life. It can be common after childbirth and during menopause when we lose the oestrogen in the local vaginal tissues. A prolapse occurs when pelvic organs, such as the bladder, bowel or uterus, shift from their normal position and bulge either down or into the front or back wall of the vagina. This can occur when the fascia, ligaments and muscles that support these organs are torn or stretched and if the pelvic floor muscles are weak.
 

Understanding Pelvic Organ Prolapse:

Pelvic organ prolapse happens when one or more pelvic organs, such as the bladder (cystocele), bowel (rectocele), or uterus, descend and press into the vaginal wall. Our pelvic floor muscles and supporting ligaments normally keep these organs in place, but certain factors, like pregnancy or heavy lifting, can weaken them, causing the organs to shift downwards.
 

Common prolapse symptoms include:

• A feeling of pressure or heaviness in the vagina
• Sensation of something being out of place, like a misplaced tampon
•  Difficulty fully emptying the bladder or bowels
• Urinary urgency or leakage

Common Causes of Prolapse:

• Several factors may contribute to the development of a prolapse:
•  Pregnancy and vaginal birth
• Heavy lifting or prolonged standing
• Chronic constipation or persistent cough
• Intense abdominal exercises beyond your control

Treatment Options for Pelvic Organ Prolapse:

• Lifestyle adjustments to reduce contributing factors
• Pelvic floor strengthening exercises
• Vaginal Pessary

In some cases, a vaginal pessary may be recommended to alleviate symptoms and improve your quality of life. It is a soft silicone device designed to provide support to your prolapsed organs. This will also help with pelvic floor muscle strengthening. The pessary puts the vaginal walls and muscles back into their correct anatomical position where they will rehab more effectively. There is also some evidence of recovery of the pelvic floor tissues after using a pessary for a period of time. 

What to Expect from a Pessary Fitting Appointment:

Our Specialist Pelvic Health Physiotherapist Louise offers personalised fittings to ensure your pessary is just right for you. Pessaries come in various shapes and sizes to ensure a suitable fit for each individual. You may prefer to wear the pessary continuously or you can choose to self-manage your pessary.

During your pessary fitting appointment a comprehensive medical history will be taken, and your symptoms and goals will be discussed with your Specialist Pelvic Health Physiotherapist. A thorough pelvic examination will assess the strength of your pelvic floor muscles and degree of prolapse, helping determine the most appropriate pessary for you. We’ll ensure you’re fully comfortable and happy with the pessary aftercare during this appointment.

With up to 85% success rate, pessaries can greatly improve quality of life. We recommend the following follow-up appointments to track progress, complete speculum checks to monitor tissue health and make adjustments if required:

Two weeks post-fitting: to assess how you are managing and ensure the pessary is working comfortably. Then three, six, and twelve months after the initial fitting: for ongoing monitoring and review.

Pessaries are considered a low-risk treatment for prolapse, though possible side effects can include increased vaginal discharge or bleeding. If you're postmenopausal, you may need vaginal oestrogen to help with lubrication, which your physiotherapist will advise on if required.