Prolapse and
Pessary Fittings

What is Prolapse?

Prolapse is the protrusion of vaginal tissue within and/or outside of your vagina.

You may have signs and symptoms of prolapse if you experience one or more of the following:

What are the signs and symptoms?

Vaginal heaviness
Vaginal dragging sensation
Sensation of vaginal bulge
Lower abdominal discomfort
Lower back pain
Incomplete bladder emptying
Difficulty emptying bowels
Discomfort with intercourse

What is a pessary and how can it help pelvic organ prolapse?

A pessary is a silicone device that is inserted into the vagina that helps to support the vaginal walls and the organs of the pelvis
Pessaries are a safe, effective and evidence-based method for the management of pelvic organ prolapse
By providing structural support, a pessary can reduce symptoms associated with prolapse, improve the efficiency of pelvic floor muscles when performing pelvic floor strengthening exercises, improve body image and sexual activity, and delay the need for surgical intervention

How can we help manage your pelvic organ prolapse at Sydney Women’s Physiotherapy?

Please note: A pessary will not be fitted during your first appointment.

Before a pessary fitting, an initial pelvic health appointment is required as your Physiotherapist must assess your needs and ensure a pessary is a safe and a suitable option for you.

Even if your doctor has referred you for a pessary, we need to complete our own assessment before proceeding. Everyone is different, and the right pessary depends on your individual symptoms, medical history and pelvic health.

What happens at your first appointment?

Your physiotherapist will discuss your medical history, medications, bladder and bowel function, and pelvic floor health. They will also assess your symptoms and determine whether any additional care is needed before a pessary can be fitted.

This assessment helps us to:

- Check that a pessary is appropriate for you and that your symptoms are not being caused by another condition that needs further investigation.
- Assess your bowel health, including constipation and your technique to empty your bowels, as this can affect how comfortably you can use a pessary.
- Check the health of your vaginal tissues to ensure they are suitable for a fitting. If your tissues are fragile or sensitive, we may recommend speaking with your GP about treatment such as use of vaginal oestrogen before proceeding.
- Assess your pelvic floor muscles and provide education or exercises where appropriate to ensure the success when using a pessary.
- Review any previous prolapse surgery, including whether you have had a mesh procedure, as this may affect your treatment options.

If anything needs further investigation or treatment, we will discuss this with you and help you understand the next steps before proceeding with a fitting.

When will my pessary be fitted?

Once your physiotherapist has completed the assessment and confirmed that a pessary is suitable, a separate fitting appointment can be arranged.

A fitting appointment can take an hour or longer, as we need time to find the best type and size, check that it is comfortable, and ensure you can safely manage your pessary. We will also explain how it works, how to care for it, and when you will need follow-up appointments.

Our priority is your comfort, safety and long-term success with your pessary. Taking the time to assess your needs first helps us reduce the risk of problems such as pain, irritation or difficulties emptying your bladder or bowels.

At Sydney Women’s Physiotherapy, we also provide physiotherapist-led group exercise classes that support patients with a safe return to exercise with pelvic organ prolapse.

Click here to download our Pessary Policies and Procedures.