Conservative Treatment Options for Pelvic Organ Prolapse (Pessaries and Pelvic Physical Therapy) - Legacy Physical Therapy
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Conservative Treatment Options for Pelvic Organ Prolapse (Pessaries and Pelvic Physical Therapy)

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One of the most common non-surgical options for management of prolapses is a pessary. A pessary is a removable device that is inserted vaginally to support a prolapse.

The pelvic organs, which include the bladder, uterus or rectum, are held in place via muscles, ligaments, and supporting tissue. When these support systems experience weakness, a prolapse can occur and the pelvic organs can descend into the vaginal space.

Varieties of POP

Common symptoms of a prolapse include 

  • Feeling a heaviness or pressure sensation in the pelvic floor 
  • Low back, hip or pelvic discomfort or pain 
  • Difficulty with emptying the bladder or bowels 
  • Bulge in the vaginal canal

Based on the level of prolapse and the symptoms you are experiencing, oftentimes your physician will recommend trying pelvic floor physical therapy, surgery or trialing a Pessary. 

A medical professional, typically a gynecologist or urogynecologist will do a full assessment to determine the best fitting pessary for you.

There are 2 main categories of pessaries: support and space-filling and several different shapes and sizes. They are typically made of a silicone material so they are durable and resist any absorption.

 A common support pessary you might hear is a “ring pessary” for this type of pessary you are able to insert and take it out without a healthcare provider. A common space-filling pessary you might hear is a “Gellhorn pessary”which must be removed and replaced by a healthcare provider. Within each type of pessary there are several different companies that make options, so speak up at your appointments if there is any discomfort. 

While pessaries do a great job of managing the bulging sensation you feel with a prolapse, there must be good pelvic floor muscle tone and strength to maintain a pessary in place! That’s where partnering with a pelvic floor therapist comes into place. Studies show combining pessary use with pelvic floor physical therapy can be very effective in the management of conservative non-surgical management of prolapse. 

A pelvic floor physical therapist will do a through exam, to assess the muscles surrounding the pessary including the pelvic floor itself, but also the core, hip and back muscles. Based on the findings, we will work with you to ensure you are feeling strong, confident and supported with a pessary. 

Want to learn more about pessary use for pelvic organ prolapse? Check out this interview we did with Women’s Health Nurse Practitioner, Julie Hake.  

If you have any questions regarding pelvic floor therapy and pessary use, don’t hesitate to give us a call!