Pessary Fitting for Prolapse – How to Know if Your Pessary Fits Well

pessary fitting

How do you know if your Pessary fits correctly?

How to avoid problems with a poorly fitting pessary?

A well fitting pessary treatment for prolapse can help you exercise and stay active, ease prolapse symptoms, prevent worsening and avoid even avoid prolapse surgery.

This Pelvic Floor Physiotherapy information teaches you:

  • The benefits of a well fitting support pessary
  • 8 ways to know if your pessary fits you well

Benefits of a Well Fitting Pessary

Potential benefits for women with prolapse from a well fitting pessary device include:

Speak with your gynaecologist or pelvic floor physiotherapist about your suitability for using a support pessary to manage your prolapse.

How to Know if Your Pessary Fits Well

pessary

Fitted Ring Pessary (Image courtesy of Bioteque)

Successful fitting usually means that the largest possible size device is fitted and sits comfortably within the vagina when you are standing upright.

Pessaries are available in a various sizes and styles to suit women’s individual differences and prolapse needs.

Prior to fitting your practitioner will assess your prolapse and measure the internal dimensions of your vagina to know the best size and style of device for your body.

A well fitting ring pessary is shown right.

8 Ways to Know if your Pessary Fits Well

1. Lying Down Flat Test

When lying flat your pessary may move down within your vagina when you cough, sneeze or hold your breath and strain however it shouldn’t move back when you relax.

If your device moves back when you relax you may need refitting with a larger size.

2. Standing Up Test

A well fitting pessary will not cause pelvic discomfort when standing up and walking.

When you cough, bend forwards, squat or hold your breath and strain the device should not move down out of your vagina. If the pessary moves to the entrance or out of your vagina you may require refitting with a larger size.

3. Bladder Emptying

The pessary should stay in place when you empty your bladder. It should not cause any change in bladder emptying such as difficulty initiating bladder emptying, slowing the flow of urine or feeling unable to completely empty the bladder.

Bladder emptying problems should be immediately reported to your treating practitioner. Learn the correct position and technique by viewing this bladder emptying video now.

4. Bladder Control

A well fitting pessary will not cause bladder control problems. Some pessaries are designed to manage both prolapse and stress urinary incontinence and may provide an alternative solution for some women seeking to manage both these problems if they coexist.

Bladder control training can assist with the management of ongoing bladder control problems.

5. Bowel Emptying

The pessary shouldn’t cause constipation or difficulty completely emptying your bowels. Bowel emptying problems should be reported to your practitioner.

Learn how to empty your bowels without straining by viewing this bowel emptying video now.

6. Physical Comfort

A well fitting pessary will not be felt within the vagina. When fitted, pessaries should not cause low abdominal or vaginal discomfort or pain in any upright or lying down position. Some women feel slight pelvic discomfort caused by the process of being fitted.

If you feel concerned about discomfort after fitting you should inform your practitioner who will assess you symptoms accordingly.

7. Fingertip Space

A well fitting pessary shouldn’t be too tight against the walls of your vagina. This can be checked by ensuring you can run a fingertip between the outer edge of the pessary and the vaginal walls.

8. Vaginal Bleeding

Vaginal bleeding when wearing a prolapse can be a sign of erosion of the vaginal walls and is this occurs, it does so after wearing the pessary for some time.

If you notice any unexplained vaginal bleeding contact your healthcare provider.

Pessary for prolapse management can make a great difference to the quality of a woman’s life and ability to stay active.

This list of the main indicators for successful fitting. If you are unsure about how well your pessary device is supporting your prolapse, speak with your health professional.

prolapse exercisesABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Prolapse Exercises Inside Out.

Prolapse Exercises is a complete exercise guide for women with prolapse and after prolapse surgery seeking to exercise safely and protect their pelvic floor.

We Welcome Your Comments

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Comments

  1. Hi I was just wondering I have had my 4th pessary ring fitted in the past 2 months the last one was last week find the first day and I am feeling the same discomfort that I felt before on the one side of the vagina wondering if you could give me some advice beginning to feel like a burden how many attempts does it take to get it right kind regards sharon

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Sharon
      What was the problem with the last attempts? What5 type of discomfort and when? Was the size of the pessary too large previously? Are you using vaginal oestrogen too?

  2. Hi,
    I had a hysterectomy and a rectocel repair, 2 years ago, due to uterus and back wall prolapse. About 2 months later I had a front wall prolpse,
    I had a pessary ( ring pessary) fitted, over the time of Covid, my pessary wasn’t changed fir 7 and a half months, she said the insides were grazed,
    Put ring back in and said used ovestin cream. Next check up , not healed, so ring left out for 2 weeks, it’s healed now.
    But a new slightly smaller ring has been fitted with a support, this doesn’t feel right at times, last night , I had short stabbing pains.
    I found the plain ring pessary better, but wondering if it will continue to graze.
    Thanks

  3. I have had 6 pessaries fitted and none have worked for me and I am in pain and discomfort as well as despair. Can anyone offer any advice or guidance. I have one in place now that hurts all the time.

  4. Thank you for this information but there are a lot of typos or sentences that don’t make sense as written.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Sandee thanks for the feedback – please just let us know where you see the typos, spell check does not reveal any our end, thanks for taking the time!

  5. Your comment is awaiting moderation.

    Hi Michelle, I was fitted with a ring pessary and it seems to fall low at the end of the day or after cardio exercise. I look a break and it seems better after more pelvic floors and recovery time but I can still feel it. The larger size was too big and felt heavier. What do you recommend? Thanks

  6. A NEW PESSARY HAS BEEN INSERTED, IT HAS A SMALL HANDLE FACING OUTWARD,,,I CAN FEEL IT,,AFTER VOIDING OR BMS, I HAVE HAD A ROSE COLOR DISCHARGE EVER SINCE,,,SAW DOC, SHE SAID ALL OK,,,STILL HAVE SMALL DISCHARGE,,,OF ROSE COLOR,, 3 WKS LATER…,NOT BRIGHT RED BLOOD,,,

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Needs to be rechecked Charlotte

      • THANK YOU FOR YOUR INPUT, SAW GYN DOCTOR YESTERDAY, SHE REINSERTED THE OLD # 5 RING PESSARY,,,SHE SAID IT SLIPPED IN PERFECTLY,,,SO FAR THIS MORNING ALL IS GOOD,,,,APPARENTLY THE PESSARY WITH THE KNOB WAS CAUSING AN IRRITATION ON WALL ,,,I WAS SO PLEASED TO FIND YOUR WEBSITE,,,I THOUGHT I WAS THE ONLY ONE WHO WORE ONE,,,I WILL WORK ON KAIGEL EXERCISE,,, I AM 87 YRS …CHARLOTTE IN FLORIDA,,,

        • Author: Michelle Kenway Pelvic Floor Physiotherapist says

          Great news Charlotte and you’re definitely not the only one to wear a pessary! Hundreds of thousands of women wear them, take care and best wishes to you!

    • Went for a pessary fitting. Doctor inserted a #5. It fell out right away. She didn’t try a bigger one just said needed a hysterectomy. Don’t want surgery, what are my options. My uterus is buldging out of my vagina about 50% of the time.

      • Author: Michelle Kenway Pelvic Floor Physiotherapist says

        Hi Nancy
        If you’re unhappy with the outcome of the consultation you always have the option to get a second or third opinion for that matter. There are numerous styles and sizes of pessary and some of the stronger space occupying designs can hold severe prolapse. I would research gynaecologists and seek out one that might be prepared to work with you on another size or design. At least in this case, if this fails you’ve tried other options too. How does this sound?

  7. Zara, I also could feel mine when I first got it. I was confused because I read so many articles that said one should not feel a well fitted pessary. I also had a lot of uncomfortable discharge when using Trimosan gel which was prescribed by the doctor. I stopped using that and the discharge stopped. However, the pessary can rub on the vaginal walls and cause irritation. Now I use Emerita, a water based lubricant. Once I figured out how to lubricate and how to insert it properly (a 30 degree twist helps when taking it out and putting it in), I became confident that this would work. It’s been 5 months now and I am aware of it when I need to add lubricant or when I let my mind fixate on it being there. Good luck.

  8. I had first ring pessary fitted yesterday. I’m not in pain but I can feel it. Is this normal? as it doesn’t feel right.
    I have thrush that I am treating does this effect things.

  9. Christina says

    Hi Michelle

    I was fitted for a Pessary June 30th 2020
    It felt fine for the first day, now when I stand for too long a time I feel pressure and discomfort along with a yellow discharge? I have been using a Premarin vaginal cream and discontinued it for a few days prior to the pessary. Will it feel better using the cream again? I have been using it regularly Monday’s and Thursday’s.
    Should I contact my gynecologist?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Christina Yes in view of the pressure and the discharge it’s best to return to see your gynaecologist for a review, all the best

  10. Hi Linda. I have a similar situation as you with rectocele. My body took a little time to adjust to a pessary. Doing Kegel exercises helped me to strenghten the muscles, and gradually, less pressure came down on the pessary and the discomfort pretty much went away. If I do start to feel it, I insert a small amount of water based lubricant (Emerita). I also take the pessary out overnight every couple of weeks, wash it, apply some lubricant and insert it in the morning. In my experience, just having the pessry inside, helped to strengthen the muscles. I also do Kegels from time to time. I am now wearing the pessary for 5 months and go about my daily activities with ease, taking care to avoid heavy lifting. I also am vigilant to avoid constipation as that tends to cause discomfort. My advice to anyone trying a pessary: Be patient. Be observant. Listen to your doctor. Initially, my doctor said I needed a larger size and I told her it was too painful. As my body adjusted to the size 3, I then went up to size 4 which is a better fit once I surrendered to this whole new and scary process. It’s worth it because the outcomes of surgery are not by any means guaranteed or long lasting.

  11. I am a new insured patient with Kaiser Permanente and do not have a lot of experience with going to any Dr. other than to be seen for colds and allergies. My husband was a nurse practitioner before he retired a few years ago. I have had 4 live births. I am 71 years old and have been in relatively good health throughout my life. I was recently diagnosed with ‘Rectum Prolapse’ by my new obgyn. He fitted me with a vaginal pessary as a possible solution. I was reluctant to even go for this appointment as I haven’t been to a obgyn in decades. I did a little studying about prolapse problems in general and was interested to see that he had diagnosed my problem bulge at the entrance of my vagina as rectum related. My question is ‘can a pessary help this problem?’ Also I went to this Dr. last week and got fitted with what I thought was a ‘too tight’ pessary, and even told him that it felt too tight and said that I was unsure how it was suppose to feel as I was having the worst discomfort that I could have with the device. Well, I no longer got home than I felt that it had fallen out. I pulled it out and didn’t want to try it again. I wonder if I just need to go back and see what else he can do for me. Please give me a little feed back so I can have the confidence I need to go on with this effort. Thank you

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Linda
      Yes a pessary can help with prolapse support and this is often a really good option for a woman to trial as opposed to having surgery.I consider it helpful that your gynae has offered you this option. There are many different types and styles of pessary, sometimes it’s difficult to get the right fit/style for rectocele management. In my opinion it’s worth returning to see your specialist, perhaps you can discuss trialing another size or style for management? There are no guarantees but it may be worth a trial. I hope this assists you

  12. Hi, Michelle,
    I have a mild cystocele and have recently been fitted with a ring pessary with support. It is very comfortable and seems to be stationary. However, I still see a small bulge of tissue when I inspect with a mirror. My gynecologist indicates that 75% of my cystocele is tucked up, but 25% isn’t. Is this acceptable?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Georgia I would think so, I hope you are doing well! You could always trial a larger size if there is room to move so to speak. Great that yours feels comfortable, this often takes some trial and error!

  13. Hello,

    I have a grade 2 bladder prolapse and a grade 3 uterine prolapse. My doctor fitted me for a ring pessary but every time I use it the knob doesn’t stay up. It flips and comes to the opening of my vagina. Is it fitted wrong? The doctor approved it in clinic but I’m not sure if it’s correct. Should it come to the opening of my vagina like that ? It’s not uncomfortable, I can just see/feel it there at the opening when I look.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Ann You’ll need to get the doctor who fitted it to check it out – it should stay in place and should not come into the vaginal opening

  14. I just got a pessary yesterday, I am experiencing pressure in my rectum and a pinching feeling by urethra. Is this normal?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Brenda
      No this isn’t normal, best to return to the practitioner that fitted it for review

  15. I have just had pressure put back after being without for 4 was the Docter put same size back thar I had before , but I am very uncomfortable with it , could my body have altered the time I didn’t have Presley in .

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Elsie
      It will need to be double checked by your doctor – it could be incorrectly fitted or even an error with the size. All the best

  16. Hi, I have been fitted with a ring pessary. I have grade 2/3 cystocele (grade was different between 2 pelvic floor Physiotherapists), Grade 1 rectocele and grade 1/2 uterus prolapse. I am 33 and have just had my 4th and likely last child. I am having mixed feelings about a pessary. I was told I could have intercourse with it in but I can’t see how. The bottom of the ring is only about 4cm in. Also, the ring feels as though it would block anything going in and be super uncomfortable for my husband. I was so excited to finally get my pessary thinking things would look more normal but I still have the bulging of my rectum and bladder in my vaginally opening. Now to add to that I have the pessary so am feeling even more self conscious. The hospital physio said they don’t do surgery to fix prolapse until women are close to 60 but I don’t want to wait that long. I just want my prolapse repaired so I can feel normal again. I am feeling so depressed about it. Do you think I can have a fulfilling sex life with prolapse and a pessary? I feel like I have the equivalent of false teeth except it’s my vagina.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Angela
      I think what you’re saying is that the pessary doesn’t suit you and at this stage you’d prefer to have a surgical repair? Surgeons can operate and perform prolapse surgery on women of any age Angela, perhaps the comment you received from your hospital physio is something to do with your country and/or public hospital system perhaps? In Australia women who have finished childbearing do have prolapse surgery at a young age if the specialist agrees and their condition warrants this. The issue is that in young women the repair needs to last for a long time and the risk of repeat prolapse in the future may be increased so this is something you would need to consider and discuss with your specialist. The other option could be to discuss using another type of pessary that may work more effectively however I can’t guarantee this would be comfortable for you during intercourse. It could be worth getting an opinion from a private gynecologist or urogynecologist with whom you could discuss your options further. I hope this gives you some future direction Angela, all the best!

  17. Hi my name is Linda I have a bladder prolapse I have a pessary fitted,this is my third one fitted and today I’m suffering with stinging and needing to go to loo every fifteen minutes,I had a repair done three years ago that didn’t work,I’m sure it’s not a UTI.Thank-you

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Linda you’ll need to have a urine test and return to your gynae to check the fit of the pessary too. All the best!

  18. Hello all! I was just fitted for a #3 pessary for rectocele. I can feel it in there, and it provides great support. But I do feel it and there is a slight burn. I am not using any vaginal creams. Does that indicate that I need a smaller size?

  19. i just got my pessary (ring size R2.50S#3) 3 days ago… it is causing pain in my rectum… should i give it a few more days or call the doctor and try either a smaller size or a different type?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Nancy, this needs to be reassessed by your doctor and probably changed for size for starters

  20. I have had a pessory for 4 years with no problems, I moved and went to a new obgyn who immediately said to consider surgery. No reason, except that I have stage 3 cystocel. I had to suggest Physical Therapyto the doctor, which I have now started. How do I find a doctor who believes in pessorys not surgery????

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Good question Sharon, are you in the US? Have you asked your Physical Therapist? She should know other Physios who insert pessaries or alternatively gynaes prepared to trial them. Let me know if you need a hand in finding someone and I’ll use contacts in the US

  21. Hey
    I m 32 year Old , with one baby of 4 months, i had a bladder prolapse 2 months ago, with the urethna and the neck of thé bladder. Doctors Say that i Can live with that, until i have all babies i Want, After have a surgery.

    But how to live like that , i pee when i cough, or walk fast.
    I Wear cup like pessary,
    Can i use pessary ?
    How many Time Can i Wear pessary ? For ever ?

    Thanks

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Kab
      You’ll need to check with your doctor or Physio who can fit your pessary regarding your suitability. Age is not an issue. If you’re suitable for pessary fitting you can wear a pessary for as long as you choose provided you take it out for cleaning and to check that there is no erosion occurring in the walls of your vagina. Some pessaries are designed to be left in for months at a time, others a suitable for day use as required and this can be discussed with your caregiver.

  22. Thank you for all your information. I hope you can help me. I have a gellhorn pessary for severe prolapse. The removal every three months is beyond bearable. I just scream, Is there anything you know that will help. I don’t think I can do this every three months. They said surgery wasn’t an option. Hi

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Nance
      This sounds like an awful problem to deal with. Obviously the more you tense the worse the discomfort however it’s all well and good to advise relaxation and deep breathing with this sort of high level discomfort. I’m inclined to suggest you discuss this with your regular trusted general practitioner who may be able to prescribe appropriate pain relief/muscle relaxant prior to fitting or he/she may be able to speak with your gynaecologist on your behalf. Why is there no possibility of insertion under sedation or even local anaesthesia? Best to discuss these options with a compassionate doctor, gynaecologist or anaesthetist. Please let me know how you go Nance, surely in this day and age we’ve moved beyond making women suffer unbearably for the sake of a pessary

      • Can’t figure out how to make a new comment so hit reply on someone’s instead. Sorry about that.

        I had one put in today. I was agonizing (I read the “slight pain” in the article and I was thinking ‘slight compared to what? LOL). Fortunately that pain was short lived although I was told it hurts more to take it out. Dreading that.

        One thing I did notice is that I now have to make a conscious effort now to completely empty my bladder as urine remains (I have stress in continence and a moderately sized rectocele) and have to contract a couple more times to empty it, more urine coming out each time . Is that normal or an indication that the support pessary is perhaps a bit big? Also I noticed that the opening in my rectum splinter is no longer centered because the knob on the pessary pushes it off to one side and makes a slight downward bulge of the tissue on the one side of the splinter. Is that normal? Will that likely interfere with bowel movements? (up until this point I often had to manually extract bowel movements due to the rectocele – hoping this thing ends that problem). I wish I had known to ask these questions at the appointment but the search I did do didn’t really mention much about complications/side effects that would include these two things.

        I have an apt in 2 weeks for a follow up with this although I read on the insert that I should have had one tomorrow and in 3 days for it to be checked. I also read that it should have been washed before inserted and they didn’t do that either. Hopefully I won’t have a problem due to that. What would be an indication that I need to be seen earlier than in two weeks because of this? I am presuming if I can’t have a bowel movement. The MD just said, when I asked, if the pain doesn’t go away (I was having some uterine cramping after it was inserted which did go away).

        Thanks. And I appreciate that you choose to answer people when you don’t get paid to do that.

        • Author: Michelle Kenway Pelvic Floor Physiotherapist says

          Hi thanks for your question. You shouldn’t need to strain to empty your bladder so yes a possible sign that it is too large. Don’t worry about the pessary being washed, they come in a sterile packet so probably more sterile not to wash it to be honest. Yes if you can’t move your bowel or bladder you need to return earlier than two weeks rather than wait to get an infection owing to residual volume. All the best

    • Hi Michelle, I can really relate to Nance’s comment (I empathise) I had the same problem with the level of pain (not discomfort) when the gelhorn shelf pessary was removed. I screamed and bled slightly. The gynaecologist decided not to put a bigger one in. I’m not advising this, but I decided to take out myself in readiness for my next appointment. I decided to squat (my yoga training may have helped) and was able to hook my finger round the knob which had slipped back (due to being the wrong size) at the same time as gently pulling on the rim. I am trying without a pessary for a month until my appointment so that I can decide whether to have another larger pessary or surgery.

  23. I have very bad pain in lower back & abdomen since getting my pessary ring , why ?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Noirin
      The pessary may be the wrong size or style, or it may not be sitting correctly. In this situation you need to return to the doctor who fitted it for assessment and appropriate management.

  24. I hade two sizes of pesserys but both fell out and the larger one was painful.

  25. Elizabeth says

    I had a ring pessary fitted yesterday. It felt quite low and when I got home I inspected and could see the white of the pessary at the entrance to the vagina. I rang the secretary to the specialist who told me I would have to wait weeks before seeing him again. I rang my surgery and was told only one dr could do this and she wasn’t there until next week!! I feel a dragging feeling and am wondering if I should be able to see it or should it be out of sight? I can touch it but it pains to try and remove it. Thankyou Elizabeth

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Elizabeth
      Is sounds as though it may be too sitting too low. If you are unable to remove it and you feel that you need it removed, see your local doctor who can remove it for you. Hope this helps

  26. My pessary has been very comfortable since having it fitted a week ago. Suddenly I feel my prolapsa again has come down and is very uncomfortable of course. I had no inkling of the pessary having come out. what could the reason for this I need to go back to the hospital for it to be investigated I think asthe prolapsa will not be pushed back. Any ideas as to what I should do to feel more comfortable ?
    Thank you

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Hannah
      The pessary has probably moved out of position. You may try to re-position it however its most likely you need to return for refitting, perhaps a larger size if it has moved.

  27. hi I have a stage 3 rectocele and was fitted for a pessary today…I noticed I can still see the bulge protruding through the vagina..is that normal..i thought with a pessary the bulge should not be seen at the opening of the vaginal area….I have a round pessary (no knob)…I really want a pessary to work…what do you suggest..i am going to contact dr tomorrow because I think I may need a different type of bigger one….

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi RS
      The pessary would usually hold up most of the prolapse, you’re doing the right thing returning to your doctor to get it checked. I’d be interested to hear the result if you have time to post.

  28. Hello Michelle,
    When I am sitting or bending I have pain at the side of my tail bone. It is not so bad if I am standing or lying. Do you think it could be caused by the pessary for my prolapse pressing against the tail bone or alternatively the actual uterus pressing against my tail bone. I have not been able to find suitable diagrams to see if this is a possibility.
    Thanking you, Dianne.

    • Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Dianne
      Tricky question – I’m more inclined to think that the pessary is pressing back against your tailbone. Can you ask your Dr to remove it so that you can test sitting and bending forwards without the pessary in place? This must be very uncomfortable for you. Keen to hear how you go, all the best Michelle

      • Thankyou Michelle, since my posting I have been back to my gynecologist and he has fitted a smaller pessary which has greatly alleviated the problem. I still get the occasional twinge so will talk to him next visit about having an even smaller one. Cheers, Dianne.

        • Michelle Kenway Pelvic Floor Physiotherapist says

          Glad to hear this news Dianne, if the smaller one isn’t effective there are different styles of pessary that don’t push back on the tailbone too – could be worth remembering for future reference. All the best to you!

          • I have worn a ring pessary for two years without any issues. Lately, I have noticed that when I remove it for cleaning it feels as if my bladder is spilling over the pessary. Is that normal?

            • Michelle Kenway Pelvic Floor Physiotherapist says

              Hi Cecilia
              Do you think your prolapse has progressed slightly? This may be the cause – check with your gynaecologist at your next appointment to ensure that your pessary is still fitting well.

  29. I had my prolapse polo ring fitted on Thursday (3 days ago) however have abdominal pain and back ache since it has been fitted what does this mean? I phoned up my Gp and she advised give it a few days for my body to get used to it ? However the pain is still there even lying down, do you think this has anything to do that I have an kntraverted (tilted) womb?

    • Michelle Kenway Physiotherapist says

      Hi Lorraine
      The ring doesn’t sound like the right fit and yes retroverted uterus can influence how well a ring pessary sits. You may need to try a number of different sizes and styles of pessary before finding the correct fit – all the best

  30. Had my pressery out in three days ago .it seems like my pelvic bone is being bothered with it as it hurts to walk somewhat and to even sit sometomes .is this normal for the first few days and will it subside in time

  31. Hi Michelle,
    Thank you for all you do. Your book, video, and web site have been very, very helpful to me.

    1. Can a pessary that is too large contribute to erosion?
    2. When do you suggest re-checking the pessary once one is comfortably fitted using the ring with block design?
    3. Are progressively more supportive space filling pessaries increasingly likely as one ages? What are the odds of this being necessary? I am 67 years old and have worn a pessary for five years (first 4 years ring design, now ring with block design).
    Thank you.

    • Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Carol

      1. Yes if a pessary is too large it can cause erosion especially with vaginal,thinning which can be counteracted using vaginal oestrogen
      2. Your specialist should recheck your pessary at least 6 mthly or earlier if you have concerns
      3. Not necessarily – you may find that the block design is adequate for your purposes. If you can do some pelvic floor exercises with the pessary in place this may assist your pelvic floor prolapse support too.

      All the best
      Michelle

  32. My Urogyn discharged me with a ring pessary I can insert and take out myself daily, with the instruction that the nurse will sent me an appointment to show me how to do it!! Am managing ok, but am not sure that I am doing it correctly although it doesn’t feel uncomfortable or fall out!.i have had a look “down there” – have had tvt and bladder repair last year, but since then ,have a grade 1 rectocele for which I need the pessary – but do not know how it should look. Help!

    • Michelle Kenway Physiotherapist says

      Hi Celia
      The main thing is that the pessary feels comfortable and is not visibly moving downwards. One of the main indicators that there is an issue is pelvic discomfort. If you are not sure best to phone the nurse and ask if she needs to see you again.
      All the best
      Michelle

  33. Hi Michelle, I was fitted with a ring with support a few weeks ago and after getting up the courage to go for a walk, it slipped down. When I tried to push it back up, it is in an upright position. Is it supposed to be going up and down or does that mean is isn’t in the correct position?

    • Michelle Kenway Physiotherapist says

      Hi Marianne

      When the pessary sits it can sometimes feel a little vertical. It should feel comfortable – if you can’t push it back into position it’s best to get it rechecked by your specialist just to make sure.

      Michelle

  34. Hi Michelle, I had a pessary fitted yesterday for the first time. I had a grade 3 prolapse of my bladder, which I could feel sticking out. Now, without the need to insert my fingers, I can feel the hard pessary sitting at the opening. Although the pessary seems to have relieved some of my back ache symptoms, I can feel the pessary a bit like a tampax I haven’t inserted far enough. Should it feel like that? Has it been inserted correctly? It is not falling out, I’m just constantly aware of the feel of it. I’d also like any advice you have about having surgery. I’ve been advised that I would need a hysterectomy. But talk of “nicking the bladder or bowel” and possible incontinence is not encouraging me to go for major surgery. Are there gynaecologists you can recommend who can perform this surgery and not leave me in worse shape than when I started??!

    • Michelle Kenway Physiotherapist says

      Hi Deborah
      A well fitting pessary should really feel very comfortable. It sounds as though you need to return to have it checked. I would suggest that you seek an appointment with urogynaecologist before rushing in to have a hysterectomy. A specialist will advise you on the most appropriate type of surgery for your condition – having hysterectomy doesn’t fix a bladder prolapse.
      All the best
      Michelle

    • Hi Deborah. I had an issue with a size 3 pessary, where I constantly felt aware of it but when I tried a size 2, it was too small and fell out. The size 3 problems were resolved when the doctor prescribed tri-san cream. Wearing a pessary can increase vaginal discharge and I noticed the pessary especially when there was discharge. The cream helps tremendously with that. The other thing that helped was to get the pessary into the proper position. When my doctor put it in, it was very comfortable. The picture Michelle has posted at the top of this blog is excellent in showing how the pessary should sit. With cream, patience and practice putting the pessary in, I now forget its in there most of the time. Hope this helps.

  35. Just had a new pessary fitted yesterday after five weeks without one in due to bleeding and ulceration and discharge. In the past I have had no pain but with this one I am experiencing pain in my rectum and difficulty passing water. Do you think I should ring the hospital where I had it fitted or should I wait and see if it settles down.

    Joan

    • Michelle Kenway Physiotherapist says

      Hi Joan

      In this case you need to ring the hospital immediately, all the best.

      Michelle

  36. I have just had my ring pessary changed and it keeps dropping down when I stand or walk and is quite painful should I seek help

    • Michelle Kenway Physiotherapist says

      Hi Sandra

      It sounds as though the new pessary is not the correct fit. You need to return to the practitioner that fitted it for review.

      Michelle

  37. Is the pessary suppose to stick out when you go to the bathroom. Tried several fits at my gynecologist today left without one. I thought when it fits, it would stay in place until it was removed. Or do you have to push it back into place everytime?

    • Michelle Kenway Physiotherapist says

      Hi Phyllis
      A well fitting pessary will stay in place once fitted. You shouldn’t have to push it back into place every time you visit the bathroom. You may benefit from another size or style of pessary.

  38. Hi just over the last couple of days am now having period pains after having my usual change of pessary (every 4-5 months) feels weird as am now 68! And haven’t had a period for years. Don’t know what is wrong – has anyone experienced this? And if so what was the solution? Thanks for replying if you can.

  39. For the past 7 years I have been wearing a ring with support pessary without a problem. I had to take the pessary out for the month of December for some erosion on my cervix which is now back to normal. My Dr. Tried to put the old pessary back , but it would not stay in. She then tried a smaller size and the same thing happened. What is the reason for this change . I’m so uncomfortable not wearing the pessary for I have a 3rd stage cystocele which is causing a bulge in my vagina. Thank- you for a comment regarding my problem.

    • Michelle Kenway Physiotherapist says

      Hi Joan
      Thanks for your comment – I really wish I knew the answer to your question but unfortunately I don’t know why the fit has changed for you. Did your doctor remeasure you? Are you now using vaginal oestrogen to strengthen the vaginal tissues following the erosion? Has your doctor trialled a different style of pessary in view of the fact that the previous one no longer suits you? I would be very interested to know why your doctor thinks the fit has changed. Wish I could help you out Joan.
      Michelle

  40. From the comments here and my own experience, I’m not sure doctors know too much about correctly fitting a pessary. I am usually very pain tolerant but when an OBGYN fitted me with a half dollar sized pessary, I was screaming in pain, and bleeding. I asked if she had a smaller one and she said no. She said it’s bleeding because my vaginal walls are thin from low estrogen and gave me a prescription, she said if I didn’t wear the pessary my herniated bladder would just get worse. I felt nauseous from the pain and pressure inside me and with the bleeding, as soon as she left the room I pulled it out. I left with a 150.00 medical bill for just the “fitting” and the pessary. I plan to make my own, I’m going to sculpt a smaller size with sculpy clay, make a mold of that, and cut up the plastic from the pessary and melt it in the cast in a toaster oven I got from the thrift shop.

  41. Hi I was 48 when I had a prolapse, I got referred to Hospital, the consultant tried a ring but it just kept coming down, he tried various sizes over a month none stayed in, he advised me that I would have to have hysterectomy which I did a couple of months later.

  42. Your information is helpful as well as appreciated

  43. carol sample says

    I have had a ring fitted for over a year now ,and its been brilliant . i have been three times and had a new one fitted. but the last time it was so painful to have it taken out and put back again , that i am dreading the next appointment.

  44. Thank you for this information, I was to see the Dr. yesterday and the pain I experienced during two fittings embarrassed me to no end. I can only say that it felt like I was being stabbed. I am not a sissy(life long power lifter and body builder) and have just my left ovary (all else gone) & that made me think the last time I had pain that bad was from an ovarian cyst which is why I don’t have the right ovary. I am 51 and not involved with anyone so therefore pain during intercourse would not be my “normal” red flag. I called the office today as I think he may have forgotten the left ovary is still there. I cannot express the distraught look on the nurses face, I thought maybe she would pass out as I couldn’t speak only scream. I felt bad for wasting their time, I hope I get some answers as I laid in bed last night and could feel my heartbeat in my pelvis (left side). Regards, Cindy

  45. Went along to my GP complaining that something wasn’t right down there, had a heavy feeling. I told her I thought I had some sort of prolapse, and felt that I needed some sort of pessary or support. After she examined me, she told me I had “loose skin, and a pessary was for old woman who could no longer have surgery” I said no its definitely a prolapse. Any way I sat in her surgery saying I wasn’t happy there was something definitely wrong, eventually she said “would you like to see a Gynaecologist”. Had to wait 3 months for a letter informing me I had to ring up a number to make an appointment. So after a total of 4 months, (after which time I had to give up work because of the pain) I eventually saw a gynae, I have a prolapsed womb! had a ring fitted. (I was delighted because I felt every thing was back where it belonged)
    Went home dam thing slipped down that night. Phoned Gynae next day, was told by receptionist that I had to see my own GP and she will put it back in.(YES THE SAME GP) So another week to go before my appointment, and there’s nothing I can do.
    Anyone tried to put it in themselves!!!

    • its helps if you soak the ring in hot/warm water first and use a lubricant. Mine fell out so I put it back in but just kinda shoved it up without any lubrication etc and it was so painful that I pulled it back out and went to see my nurse who said ‘ooooh a bet that hurt’ and told me about soaking it first and using lubrication! six months down the line of wearing it and just having had it changed the latest fitting is not going so good. I can feel it there all the time and it feels sore like it is rubbing my insides. I’ve been reading the blog and think I should check on the fitting. I am also feeling like pulling it out to see if I feel any better but then I remember how bad I felt before I had one fitted. I know I will have to do something very soon as I am getting depressed and just want to sit down all the time. I am now an ex runner (cos its just not worth the pain) and I dont exercise anymore apart from walking but then it is so painful. Ho hum, what a life

  46. Hello everyone. I’m in UK and have just had a ring pessary fitted today. I noticed over a year ago that I couldnt pee properly and suspected I had a slight prolapse. I didnt see the doctor as it was manageable. A couple of weeks ago I couldnt go to the toilet either end and ended up feeling quite ill with headache, hot and cold, and feeling sick, so I saw the doctor who arranged for me to have a ring pessary fitted within a couple of days.
    It feels ok in fact I cant feel it at all and am hoping this wont change and everything will be ok. I was very well looked after here in UK by my local GP and the procedure was done at a medical centre half an hour from where I live.
    I have felt so much better since I went to the doctors and urge anyone if they are a bit afraid or apprehensive to just do it. It will make you feel so relieved being able to talk to someone about it.
    I have been very active (63yr old) doing about 7 workouts a week (yes I know a bit over the top and yes I put my hand up and admit it prob made my prolapse worse) but at the time it wasnt causing too much problem. Now I have decided to have a rest but at the back of my mind I would still like to know if exercising is a possibility or a definate no no. I didnt ask the gp about it as it was the last thing on my mind and I dont want to just go ahead and hey presto end up back to square one, but at the same time would like to do something and might my life be kinda empty now.
    What exercise does anyone do and were you a bit afraid of trying anything in the first days of your fitting

  47. Thank you Michelle for your valuable information. The information on “How to Know if Your Pessary Fits Well” is very educating for me as well as your other information.
    I too am interested in finding out about a pessary that’s good for a rectocele as well. I have a cystocele and rectocele grade 2 and a uterine grade 1. I was told by the last urogyncecologist that my cystocele and rectocele were grade 3; but I don’t have them protruding out of my vaginal opening. I just have the cystocele right there at the entrance. I can see the bulge; so I kinda feel this possibly that his grading was not correct.
    I wear a ring with support pessary occasionally but I sometimes feel to is too tight because, after wearing for a while it tends to make my low back slightly ache. I have tried to see if I can run a finger between the pessary and the wall of the vagina and I don’t know if my fingers are short or I just can’t seem to reach to move my finger between. I can in the front of the pessary but farther in I can’t seem to reach well to see.
    Thank you for all your information.
    Warm regards,
    Jo Ann

    • Michelle Kenway says

      Hi Jo Ann
      Yes this is tricky isn’t it. Problem is also that every time you go and try a new pessary there is an added expense, it would be nice if the process was easier and we could all be more certain of the right size and style that’s for sure. Maybe in years to come they’ll use 3D imaging or something who knows, at the moment it’s trial and error and some measuring.

      Guidelines for pessary fitting do state that the wearer of the pessary should not be aware of it being in place, it should be pain free and that the finger should run around the rim, I see you have tried this. in view of the discomfort you are prone to feeling it would be worth getting a review of the fit of yours.

      It may well be that a different style of pessary might suit you better. The Gellhorn and the Cube pessary are both space occupying pessaries and often used in moderate prolapse conditions. It might be worth reading a little more about these two styles of pessary and discussing the possibility of this option with your gynaecologist – it is just a suggestion you may or may not wish to act upon. It would be nice for you to be feeling comfortable.

      I hope this helps you out – always keen to hear how you go, it helps other women too!
      All the best
      Michelle

      • Thank you so very Michelle for you valuable information. I plan to see a urogynecologist in April. That was the earliest appointment. I’m hoping to see if he can try those pessaries or others that I will feel comfortable with and not feel the discomfort and pain I feel afterward, like I do with the ring with support.
        I recently wore the ring with support pessary for 3 days without removing it because I was at the hospital with my mother who was in ICU and finally after three days I removed it. I noticed when I had a bowel movement aftwards I was feeling pain in the rectum. When I got home and removed the pessary, I have had pain and discomfort now for 3 days, rectal pain as well as pain on my lower left side of my abdomen. I definitely feel I can’t wear this pessary any more. I just feel so sore, so something is not right with either the shape or size or both.
        Again thank you so very much for your information. I’m hoping that when I see this urogynecologist he will prescribed pelvic health physical therapy. I’ve heard he is very positive on Woman’s Health pelvic floor physical therapy and that will be very beneficial for me.

        Kind regards,
        Jo Ann

  48. christine rogers says

    Brilliant to hear from you Michelle; you have helped me so much and given necessary reassurance. Am thrilled to hear from you, with timely exercise revision, as you are an inspiration.
    What are your findings on pessaries for rectocele support? (I am still finding it difficult to find an interested / willing doctor in the U.K.)
    Hoping you are well. Kindest regards,
    Christine

    • Michelle Kenway says

      Hi Christine

      Thank you for your feedback! The success of pessary for rectocoele support can sometimes depend in part on the size of the prolapse – somtimes larger rectocoele can make some pessary fitting difficult as the pessary can be pushed out of place by the prolapse. However one study (Cundiff et al 2007) found that the Ring Support and the Gellhorn pessaries were used with equal success for all types and stages of prolapse. The space filling pessaries like the Cube or Gellhorn pessaries are often used for moderate to severe prolapse (stage 111 or 1V). Ring pessary is often the first pessary trialled for Stage 1 or 11 prolapse. I have found that the space occupying pessaries sometimes work more effectively for women with rectocoele hwever there is no hard and fast rule on this.

      There has to be a gynaecologist willing to fit a pessary in the UK! Can anyone help Christine out here? If not leave it with me Christine and I’ll chase one up.
      Cheers
      Michelle

      • christine rogers says

        Always there to rely on Michelle – what would we all do without you? Crazy.
        Thanks yet again.

        Regards, Christine