When should you consider a pessary?

For many women with pelvic organ prolapse, management starts with understanding the factors that may be contributing to symptoms and addressing these conservatively.

This may include:

• Pelvic floor muscle training

• Optimising bladder and bowel habits

• Managing constipation and avoiding excessive straining

• Learning how to manage pressure through the abdomen during lifting and exercise

• Modifying activities that significantly aggravate symptoms

• Gradually building strength, fitness and confidence

• Understanding how prolapse symptoms respond to different activities and positions

For some women, these strategies are enough to manage their symptoms comfortably.

However, if you have worked on these areas and are still experiencing bothersome prolapse symptoms, a pessary can be a valuable additional treatment option.

A pessary can provide mechanical support to the vaginal walls and pelvic organs, helping to reduce the sensation of heaviness, pressure or bulging.

It can be particularly useful if you want to remain active but find that symptoms increase with activities such as:

• Running

• Strength training

• Walking for longer periods

• Standing for extended periods

• Lifting

• Higher-impact exercise

Rather than replacing pelvic floor rehabilitation, a pessary can be used alongside it.

Think of it as another tool in your prolapse-management toolbox.

Why consider a pessary?

Sometimes, despite doing all the "right things", prolapse symptoms don't completely disappear.

That's where a pessary may help.

For example, you might have good pelvic floor strength and be managing your bowel habits well, but still experience a feeling of vaginal pressure when you run.

A pessary can provide additional support during that activity, potentially allowing you to exercise more comfortably and confidently while continuing with your pelvic floor rehabilitation.

Some women use a pessary every day, while others only use one for particular activities such as running, gym sessions or longer days on their feet.

The choice is individual and should be based on your symptoms, goals, anatomy and lifestyle.

Who can fit a pessary?

Pessary fitting is not limited to specialist medical settings. Pelvic health physiotherapists with appropriate training can assess, fit and review pessaries as part of conservative prolapse management.

A physiotherapist will assess your individual presentation and help determine whether a pessary is appropriate for you. They can also work with you to find the most suitable type and size and assess how it performs during movement and activity.

There can sometimes be a little trial and error involved. That's completely normal. Different pessaries suit different bodies, and finding the right fit is about more than simply matching the pessary to the stage of prolapse.

What about ACC funding?

If your prolapse is related to a covered maternal birth injury (MBI), ACC may fund pelvic health physiotherapy and, where clinically appropriate, pessary treatment.

Eligibility and funding are dependent on your individual ACC claim and circumstances.

If you have an ACC MBI claim and are experiencing ongoing prolapse symptoms despite conservative management, talk to your pelvic health physiotherapist about whether a pessary could be appropriate for you and whether it may be covered under your claim.

A pessary isn't a sign that your pelvic floor rehabilitation has failed.

Sometimes your body simply benefits from a little additional support.

The goal is not to "fix" your prolapse with a device. The goal is to help you manage your symptoms, stay active and do the things that matter to you, while continuing to work on your underlying pelvic floor function and overall health.