Pessaries: A Review

A review addressing pessary use and quality of life is available in PubMed central. Pelvic rehabilitation providers are often in a role of educating patients in what a pessary is, in finding a provider to fit a pessary, or in discussing with the patient the potential benefit of such a device for reducing symptoms of pelvic organ prolapse. If you are unfamiliar with a pessary, click here for information from WebMD.

The history is pessaries is impressive, and this article begins with a reference to Hippocrates who used a pessary made of a halved pomegranate soaked in wine. They are now usually made of silicone, and come in many shapes such as a ring or a donut. In terms of which patients benefit from a pessary, the authors point out that from the literature, this appears to be mainly a subjective experience on the part of the patient related to perceived benefit of pessary use. Some patients have difficulty keeping the pessary in, especially with Valsalva, and then choose to stop using it.

In terms of measured outcomes of pessary use, the authors are critical of the lack of standardized gynecologic outcomes scores used in patients who are successfully fit with a pessary. One study by Abdool (2010) that is referenced, however, suggests that outcomes of pessary use match those of surgery. Factors influencing a successful fit may include use of local hormone supplement such as estrogen cream to improve tissue health and avoid vaginal irritation. An unsuccessful fitting may occur with a "...short vaginal length, a large genital hiatus, prior history of hysterectomy and prior repairs of POP [pelvic organ prolapse]."

Because there are known potential medical complications from use of a pessary, the Pelvic Rehabilitation Institute does not encourage physical therapists to fit for or manage a patient's use of a pessary. It may be incredibly helpful to a patient, however, if you can provide education about what a pessary may offer a patient. This might mean that you have to make phone calls and find out what providers in your community are fitting pessaries. Some providers discourage the patient from its use because of the challenges of getting the right fit. I encourage patients to follow-up readily with the provider doing the fitting so that this can be corrected. I found it to be a very useful option for many patients as it provides a conservative choice prior to surgery. Following one of my patients to her provider's office during a pessary fitting also helped me to better understand the procedure. What a wonderful way to demonstrate to your patient and to providers that you are engaged in a patient's care.