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Considerations

In addition to the contraindications discussed in part I which must be addressed before a pessary can even be considered (red flags), there are situations in which pessary use must be considered with caution (yellow flags). Safety and appropriateness of pessary use is to be considered on an individual, case-by-case basis in these instances.

• Neurological bladder problems
  • In the case of neurological reasons for bladder problems, including multiple sclerosis, Parkinson’s disease, or spinal cord injury, pessary use must be considered with whole body health of the individual considered.
• Severe constipation
  • Constipation must be addressed in the presence of pelvic organ prolapse, perhaps even before a pessary is considered. Your physiotherapist will discuss with you many factors relating to constipation including diet, water and fibre intake, exercise, stress and anxiety, muscle tension, pain in the pelvic region, normal bladder and bowel habits, ideal toileting position and more. Constipation and chronic straining to have a bowel movement is believed to be one of the causes of pelvic organ prolapse so it is imperative to develop a treatment plan to best manage your constipation. After a plan is implemented, a pessary may be considered for your pelvic organ prolapse symptoms. It is important however, that the pessary prescribed for you doesn’t prevent you from evacuating your bowels easily and completely. If you find you are having increased difficulty passing stool with your pessary in, contact your fitting physiotherapist or other health care professional immediately; perhaps another size or shape of pessary is better suited for you.
• Overactive bladder
  • Overactive bladder (OAB), which is defined as having frequent, uncontrollable urges to urinate with or without urinary leakage, is not a bladder condition that warrants pessary use in and of itself. If a woman has OAB in addition to pelvic organ prolapse or stress urinary incontinence, a pessary may still be an appropriate treatment approach, but it must be noted that the OAB specific symptoms will likely not be improved with pessary use.
• IUD
  • If you have an IUD, pessary use is still an option for you; however, you must be careful not to pull on the IUD strings that stick out beyond the cervix when removing your pessary. If your cervix sits particularly low, a pessary might not be the best option for you as the strings may be pulled during pessary removal. Discuss with the health care professional inserting your IUD if cutting the strings a little shorter than normal is appropriate if you are using a pessary as well.
• Sexually active
  • Some pessaries can be left in during intercourse and some must be removed. Your fitting physiotherapist will advise you what kind of pessary you have. Whether you are sexually active or not will be taken into account when choosing the best pessary for your symptoms and lifestyle, as some are much easier to remove than others. In general, ring pessaries with or without support and the shaatz can be left in during intercourse; rings with a knob, the double or single cube, donut, and gellhorn must be removed for intercourse.
• Menstruation
  • If you are of menstruation age, a pessary is definitely a possibility for you. It must be noted, however, that a tampon or menstrual cup must not be used at the same time as a pessary, in order to minimize the chance of infection. So either you don’t use your pessary during your cycle and use a tampon or cup, or you use your pessary and wear pads.
• Pregnant
  • If you are pregnant and experiencing pelvic organ prolapse symptoms, a pessary may be an option for you. However, you will have to speak with your obstetrician to determine if this is an option for you. A physiotherapist cannot fit you for a pessary if you are pregnant; this must be at your OB’s discretion.

If any of the above are true for you, be sure to inform your physiotherapist or fitting health care professional so she/he can provide you with the most appropriate treatment options.

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.