Pelvic Organ Prolapse & Pessaries

What is that feeling of heaviness in my perineum?

Our experienced physiotherapists can help you feel great despite the prolapse and live your life with confidence! We have been successful treating this problem both in-clinic and online..

WHAT IS IT?

Pelvic organ prolapse occurs with the organs within the pelvic cavity lower down from their original position. It can also be referred to as pelvic organ descent. This phenomenon is more common in females, but can also occur in males. Patients may have symptoms (feeling of heaviness in the perineum, the sensation that there is a “ball” obstructing the vagina, difficulty passing stool orurine, a urine incontinence), or may be completely asymptomatic. Typically, the more progressed a prolapse is, the more likely you are to have complaints.

The three main types of organ prolapse are as follows:

Bladder (cystocele)

This occurs when the bladder descends and begins to obstruct the vagina

Uterus (ureterocele)

This occurs when the uterus descends and begins to obstruct the vagina

Rectum

Rectal prolapse: when the rectum protrudes from the anus
Rectocele: When the rectum balloons and begins to obstruct the vagina

Bladder (cystocele)
This occurs when the bladder descends and begins to obstruct the vagina
Uterus (ureterocele)
This occurs when the uterus descends and begins to obstruct the vagina
Rectum
Rectal prolapse: when the rectum protrudes from the anus
Rectocele: When the rectum balloons and begins to obstruct the vagina

WHAT CAUSES IT?

Often, it’s a combination of factors that will lead to the development of a prolapse:

History of constipation necessitating inappropriate pressures while voiding

Childbirth

Weak pelvic floor muscles decreasing the support of the pelvic organs

Inability to moderate abdominal pressures with your abdominal muscles

HOW CAN PHYSIO HELP?

As pelvic floor physiotherapists, our role is to evaluate the above factors and identify the most likely cause for your situation. We will then create a treatment plan to address the problems. It is important to note that physiotherapy can not fix a prolapse that has already occurred. Our role is in decreasing or abolishing related symptoms, and in preventing worsening of your condition through the specific application of exercises, manual techniques, and retraining many habits and mechanics of your body.

WHAT IS A PESSARY ?

It is an object, often made of medical grade silicone, which is placed in the vagina to support the organs or to control urinary incontinence. It is a conservative, non-surgical approach to managing the symptoms of several types of organ prolapse.
It’s quite simply a bra for your organs! They come in different sizes and shapes so everyone can find one that suits them.

WHAT IS IT USED FOR ?

A pessary provides support to the vaginal walls to prevent the organs from moving downward into the vaginal space. The most common pelvic organ prolapses are descent of the bladder (cystocele), rectum (rectocele) and uterus (hysterocele).

The symptoms of descending organs are vaginal heaviness sensations or sensations that a lump is coming out of the vagina, sometimes accompanied by pain and/or irritation. A well-suited pessary can also help control incontinence during sporting activities such as running.
That said, a good pelvic floor musculature remains important both in terms of managing symptoms of heaviness, urinary incontinence, and being able to use a pessary effectively.

WHY USE IT
IN PHYSIO ?

Our experienced physiotherapists can do a fitting to try different pessary sizes and types, provide education on how to use and manage the pessary, and offer follow-up visits to ensure its safe use.

Prior to taking your appointment for a pessary evaluation, a doctor's prescription is necessary to assess the quality of the vaginal mucosa before using a pessary. In some cases, your doctor may suggest applying a cream to improve your vaginal health before starting to use the pessary.

The frequency of follow-ups varies on a case-by-case basis. During a follow-up, your therapist will ensure the pessary is in good condition, your comfort in different activities and positions and review with you the steps of inserting and removing the pessary. The size and shape of the pessary may need to be adjusted as your vaginal tissues change.