I get a ton of great referrals from fellow physiotherapists who don’t fit pessaries themselves. Most of the time they are appropriate referrals, but every once in a while, the patient referred is not appropriate for one reason or another. Let’s take a moment today to review when it’s most appropriate to refer a patient for a pessary, for either stress urinary incontinence (SUI) or pelvic organ prolapse (POP).
When to Refer
- You have exhausted pelvic floor muscle training options and, while there has been some improvement, you client is not quite satisfied with the results and is still experiencing SUI or POP symptoms.
- Your client is on the wait-list for surgical repair of SUI or POP symptoms but, as we all know, this can be a long wait. Pessaries can be a lifesaver to help ease symptoms while she awaits surgery.
- Your client is open to considering surgery at some point in her life, but, due to the recurrence rates of surgery, wants to defer as long as possible.
- Your client has SUI or POP but wants to have more children. Pessary use can be a great option between children, a time when surgery isn’t an option.
- Your client is post-partum and wants to resume exercise but is fearful due to her diagnosis of POP or her SUI symptoms. Using a pessary can help give her the confidence and peace of mind she needs to resume exercise, which we know is imperative for whole body and mental health.
When Not to Refer
- If your client has had pelvic surgery that used mesh. Mesh surgery is an absolute contraindication to pessary use.
- If you client is pregnant. Pessary use is still possible if your client is pregnant. However, she must be fit and monitored by her OBGYN; physiotherapists cannot fit a pregnant woman with a pessary.
- If your client has vaginal atrophy to the point of not being able to do a 2-digit exam, she likely needs a prescription of topical estrogen and/or dilator work prior to pessary fitting. I am happy to see her for guidance regarding these preliminary steps, but she should be informed that pessary use might be a little bit down the road.
If you have any questions regarding client referral, we would be more than happy to discuss. Just give us a call- we’d be thrilled to collaborate with you!
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.