Use of a pessary can be life changing for the better when it fits well and does what it’s supposed to. Studies have shown that as many as 90% of women reported that they found a pessary useful to help manage their symptoms. This statistic shows that the large majority of women will find benefit, but that not 100% will.
Pessary fitting is trial and error. There are a wide variety of shapes and sizes of pessaries, so if one doesn’t work, others can be trialed. However, in some cases, even after all the appropriate shapes and sizes have been explored, a woman may still find that it does not work for her for a variety of reasons. Below are some of the most common reasons a pessary may not work to correct pelvic organ prolapse (POP) or stress urinary incontinence (SUI) symptoms.
- You cannot tolerate the feel of a pessary, despite trying different shapes and sizes.
- Ideally, you shouldn’t feel your inserted pessary at all; however, some women report they are aware of their pessary for a period of time before their body adjusts, after which time they are no longer consciously aware of the pessary’s presence.
- You get recurring infections when using a pessary (urinary tract infection, yeast infection, etc).
- If this is the case, speak to your doctor about the use of a topical estrogen, vaginal probiotic, or other topical to see if correcting the pH balance of your vaginal flora rectifies this problem before giving up on your pessary.
- You have vaginal atrophy which is not sufficiently corrected with topical estrogen.
- Vaginal atrophy results in decreased blood flow to the tissues, as well as decreased thickness, flexibility, and robustness of the tissues. Therefore, the pessary may cause lesions or sores on the vaginal walls. A prescribed topical estrogen will often correct this problem and make the use of a pessary tolerable and safe, but occasionally topical estrogen does not reverse the atrophic changes enough for a pessary to be a viable option.
- Your pelvic organ prolapse is not re-positioned sufficiently to improve your symptoms.
- No matter how many pessaries you try, you don’t feel an increase in support, nor are your symptoms reduced with the insertion of a pessary.
- Your vagina has been shortened, such as after a total hysterectomy.
- This makes the fitting of a pessary more difficult. Sometimes there is not enough room to comfortably fit even a small sized pessary and have it support your organs sufficiently.
- You have a large vaginal opening and a pessary won’t stay in.
- Some anatomical variations lend themselves to keeping a pessary in and others have the opposite effect. Some vaginal shapes just don’t hold a pessary in place as well and this is true if your vaginal opening is relatively large.
- Your tissue is too soft or lax that a pessary won’t stay in place or support the organs sufficiently.
- Pessaries remain in place by two main methods: they lodge themselves in the soft tissue of the vagina and rest on/behind the pubic bone, or they suction to the vaginal walls (the cube). Sometimes the soft tissue of the vagina is too soft or lax to hold the pessary in place. This will result in the pessary repeatedly slipping down or easily falling out, even when it is the appropriate size.
- Sometimes this can be reversed to some degree with pelvic floor muscle training. Doing consistent pelvic floor muscle contractions will help to bulk up the muscles and sometimes this is all that is needed to hold the pessary in place. Make sure to see a pelvic floor physiotherapist to ensure doing kegels is right for you (it is not for all women) and that you are doing them correctly. If you are not using the muscles correctly, you are wasting your time at best, and potentially making things worse, at worst.
- The pessary does not anchor on/behind your pubic bone.
- Many pessary styles are designed to sit on/behind the pubic bone. It’s almost as if the pubic bone creates a “shelf” for the pessary to rest on. Sometimes anantomical variations of the pubic bone make it seem as if there is no shelf for the pessary to rest on and the pessary just slips down. It can be difficult in this case to find a pessary shape that remains in a comfortable, supportive position.
- When the prolapse is corrected but masked stress urinary incontinence results.
- Sometimes a prolapse will “hide” urinary leakage and then when the bladder is re-positioned, stress urinary incontinence results (leakage with activity- coughing, laughing, sneezing, standing up from a seated position, running, jumping, etc). If you experience this, try a differently shaped pessary- one designed for both POP and SUI. However, if this new, unwanted symptom of urinary leakage is not sufficiently corrected with a pessary designed for both SUI and POP, then you may choose not to use a pessary at all.
If you have been fitted with a pessary but aren’t convinced that it is the best size or shape for you, give us a call to see if there is a better option for 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.