Types of Pessary for Successfully Treating Prolapse With Pros & Cons

Types of pessaryMany types of pessary are designed for prolapse management.

Fitting the right pessary usually involves trial and error.

Women often need to try out a number of different pessaries to get the right fit, a little like trying out a new pair of shoes.

The type of pessary you’re fitted with determines the overall success of conservative prolapse management so it helps to know your options.

This Pelvic Floor Physical Therapy information helps you know:

  • Common reasons for using a pessary
  • Different types of pessary for treating vaginal prolapse including of advantages and disadvantages of:
  1. Ring pessary
  2. Gehrung pessary
  3. Donut pessary
  4. Cube pessary
  5. Gellhorn pessary
  6. Inflatable pessary
  7. Shelf Pessary

Common Reasons for Using a Pessary

Some of reasons for using a pessary are:

  • Desire to avoid or delay prolapse surgery
  • Waiting for prolapse surgery
  • Exploring alternatives to prolapse surgery
  • Desire to exercise safely with a prolapse
  • Desire for future pregnancy

Types of Pessary for Treating Vaginal Prolapse

There are many different types of pessary designed for managing prolapse.

Pessaries are manufactured in different sizes to suit individual differences in internal dimensions.

The types of pessary best suited to managing your prolapse depends upon your:

  1. Type of prolapse
  2. Prolapse severity i.e. mild, moderate or severe
  3. Vaginal dimensions

Pessaries can be grouped into 2 categories:

  1. Support pessaries that elevate or lift up the prolapsed tissues within the vagina usually for mild to moderate prolapse e.g. Ring or Gehrung pessary
  2. Space occupying pessaries that fill the space within the upper vagina usually for more advanced or severe prolapse e.g. Donut, Cube or Gellhorn pessary.

1. Ring Pessary Ring Pessary

The Ring pessary is the most commonly fitted pessary (shown right). This type of pessary is a support pessary and it’s usually the first style of pessary trialled during fitting.

Ring pessaries are available in a couple as a ring only or combined with a small block design to manage prolapse and stress urinary incontinence (bladder leakage with cough or sneeze). The additional block supports the urethra (urine tube) with the goal of reducing leakage when pressure is placed upon the bladder.

Pros and Cons

  • Easily inserted and removed
  • Used for most types of prolapse
  • Patients can usually be taught to remove this pessary themselves
  • Does not need to be removed for intercourse

Prolapse Type

Suited to all types of prolapse

Prolapse Severity

Mild to severe (best suited to less severe mild to moderate prolapse).

2. Gehrung pessary Gehrung Pessary

The Gehrung pessary is a support pessary (shown right).

Pros and Cons

  • The Gehrung pessary can be moulded or customized to fit
  • Does not need to be removed for intercourse
  • Provides strong support
  • Difficult to fit and remove

Prolapse Type

The Gehrung can be used for cystocele, rectocele and /or uterine prolapse

Prolapse Severity

Mild to severe (best suited to less severe i.e. mild to moderate prolapse).

Donut Pessary Donut Pessary

The Donut is a space occupying pessary (shown right).

Pros and Cons

  • Used  for different types of prolapse including uterine prolapse
  • Difficult to remove owing to size and thickness (difficult to squeeze and compress)
  • Donut pessary needs to be removed for intercourse

Prolapse Type

The Donut can be used for different types of prolapse including cystocele, rectocele and/or uterine prolapse.

Prolapse Severity

Most suitable for moderate to severe prolapse.

Cube Pessary Cube Pessary

The Cube is a space occupying pessary (shown right).

The Cube pessary has curved surfaces that adhere (stick) to the walls of the vagina. The Cube is attached to a plastic loop (like a tampon string) that sits within the vagina to assist removal.

Pros and Cons

  • Needs to be removed every night
  • Difficult to insert and remove
  • Cube pessary needs to be removed for intercourse
  • Sometimes associated with increased vaginal discharge
  • May cause vaginal erosion

Prolapse Type

The Cube can be used for different types of prolapse including cystocele, rectocele and/or uterine prolapse.

Prolapse Severity

Most suitable  for moderate to severe prolapse.

Gellhorn Pessary Gellhorn Pessary

The Gellhorn pessary is a space-occupying pessary. It has a circular base with a curved surface. The curved surface provides suction keeping the pessary in place.

Pros and Cons

  • Difficult to insert and remove.
  • Removal requires the use of forceps to grasp the stem of the pessary
  • The position in the vagina can change
  • Gellhorn pessary needs to be removed for intercourse

Prolapse Type

The Gellhorn pessary be used for different types of prolapse including cystocoele, rectocele and/or uterine prolapse.

Prolapse Severity

Most suitable for moderate to severe prolapse.

6. Inflatable Pessary Inflatable Pessary

Inflatable pessaries are manufactured in Donut and Ball designs. These are space occupying pessaries. They have a tampon-like extension for inflation and removal. Inflatable pessaries are expanded using a hand held pump once fitted in position.

Pros and Cons

  • Easy to insert and remove
  • Inflatable pessary needs to be removed for intercourse

Prolapse Type

Suitable for use with uterine, cystocele, rectocele, small bowel and/or rectum.

Prolapse Severity

Suits mild to severe prolapse depending on the type of prolapse.

7. Shelf Pessary Shelf Pessary

The Shelf pessary is a rigid type of pessary suited to more advanced prolapse. More flexible silicone Shelf pessaries have recently been manufactured.

Pros and Cons

  • Difficult to insert and remove
  • Shelf pessary needs to be removed for intercourse

Prolapse Type

Suitable for use with prolapsed uterus or procidentia (prolapse protrudes out of vagina)

Prolapse Severity

Suits moderate to severe forms of prolapse.

Types of Pessary Key Points

  • There are many different types of pessary for managing prolapse
  • Pessaries are manufactured in a range of sizes
  • Different types of pessary are designed for managing a specific type of prolapse
  • The Ring pessary is the most commonly fitted pessary for managing vaginal prolapse
  • Getting the right pessary often involves trialling a range of styles and/or sizes

Further Reading

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

» How Pessaries Can Help Prolapse Symptoms And Support

» How Severe is Your Prolapse? Understanding Your Prolapse Diagnosis

Prolapse Exercises Book

This complete exercise guide is especially for women with prolapse and after prolapse surgery seeking to exercise safely, reduce the risk of prolapse worsening and improve prolapse support.

Prolapse Exercises Book

Prolapse Exercises teaches you how to:

  • Relieve prolapse symptoms
  • Avoid unsafe exercises
  • Choose pelvic floor safe exercises
  • Reduce your risk of prolapse worsening
  • Improve prolapse support
  • Increase your strength and fitness
  • Recover after prolapse surgery
  • Return to exercise safely
  • Strengthen your core
  • Lose weight

    Learn More

ABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is an Australian Pelvic Floor Physiotherapist. Michelle lectures to health professionals and promotes community health through her writing, radio segments, online exercise videos and community presentations. She holds dual post graduate physiotherapy qualifications in women’s health and exercise.

References

Jones K. & Harmanli O. (2010) Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence. Rev Obstet Gynecol. Winter; 3(1): 3–9.

We Welcome Your Comments

Comments

  1. Hi Michelle,
    I am 67 years old with uterine and bladder prolapse. I have your exercise video and book, do daily pelvic floor exercises, and wear a pessary (ring with small block design).

    I remove my pessary each night to prevent erosion. I wake up 3-4 times during the night. I have tried wearing supportive underwear at night and sometimes wear the pessary. I still wake up. Do you have any suggestions?

    Thank you.

    • Michelle Kenway Physiotherapist says:

      Hi Dee
      There’s really no benefit from wearing support underwear at night as there is no pressure on your prolapse when you’re lying down. What do you think is waking you up?

      • Hi Michelle,
        Thank you for your reply. Is night time awakening correlated with bladder prolapse? I am unsure why I awaken during the night but wondered if prolapse might be a contributing factor.
        Thank you.

        • Michelle Kenway Physiotherapist says:

          Hi Dee
          No problem! Your prolapse is unlikely to cause you to wake up. Do you wake up needing to empty your bladder or otherwise? It’s normal to wake up once during the night to empty the bladder. Let me know Cheers

          • Hi Michelle,
            Thank you for your reply. I truly appreciate it.

            I am unsure why I awaken 3-4 times during the night. I immediately use the bathroom so hopefully I won’t be awakened by needing to go. My output is usually small. I am not tired during the day.

          • Michelle Kenway Physiotherapist says:

            Hi Dee
            When voids are small during the day the bladder capacity decreases so that when the bladder fills in the night it causes wakening. Bladder retraining involves increasing how much the bladder can hold during the day, avoiding drinks high in caffeine and ceasing drinking well before bed time can make a big difference too. A Pelvic Floor Physio can help you with bladder retraining. All the best, Michelle

  2. Thank you for the really detailed information about pessaries. I have been wearing a ring pessary for almost two years now and don’t really know what I would have done without it. I am not a young woman but my experience may be useful for others to read.
    I was fortunate to have had very little prolapse problems in spite of having had four children and also two serious abdominal surgeries as a child, but in my 60’s following surgery to remove an ovary my uterus prolapsed and however much i kept good posture, bowel habits and did recommended exercises etc. things got worse. I couldn’t walk far without my uterus rubbing on my underwear and bleeding. I would have liked to have managed things by doing the exercises but for whatever treason there was no improvement.. I’ve seen using a pessary described as rather a second best situation, but to anyone old or young if its your best option, go for it. When it fits well you can forget its there; my partner jokingly calls it my ‘implant’ but it rarely gets mentioned now. I think of it as doing what a mesh can do but without the risks that mesh can bring .After a while its easy to take it out and put it back!
    I am interested to know whether there is any evidence to support the possibility that doing the pelvic floor exercises recommended in ‘Inside Out’ while wearing a pessary might result in a certain improving of symptoms useful if not wearing it.
    Thank You.

    • Michelle Kenway Physiotherapist says:

      Hi Jan
      Thanks so much for providing this information. I’m sure your experience will help other women considering using a pessary for prolapse management. Interesting that you raise the question of pelvic floor exercises and wearing a pessary. There has been a recent randomised control trial completed that found that in mild to moderate prolapse, women wearing a pessary who performed pelvic floor exercises had a greater reduction in prolapse symptoms and improved quality of life when compared with women who did only pelvic floor exercises. Hope this answers your question Jan, Cheers Michelle

      • Hi Michelle,
        Thank you for this. I’ve looked at these results. It almost looked as if wearing a pessary enabled the pelvic floor exercises to be done more efficiently. Having moved house a while ago I don’t really have regular prolapse clinic appointments any more but think I may try the exercises again a little and often and see what happens.

      • Hi Michelle,
        Thank you for the information on the randomised control trial involving pessary use. Seems as if wearing a pessary may help in doing the pelvic exercises effectively. Having moved area and GP I don’t now have any regular monitoring for my prolapse but I guess it would be a good idea to return to more pelvic exercises now and see what happens.

        • Michelle Kenway Physiotherapist says:

          I don’t see that you’ve got a lot to lose in returning to your exercises provided you’re using the correct technique Jan

  3. Hello Michelle! I had a pessary for about 8 months when I was 56 years old. It was a ring type that looked like a diaphragm with two small button-sized holes in it. It did help. However, I was constantly getting yeast infections and three bacterial infections from it despite my being very careful to remove it and insert it after showering with clean hands and nether parts. Unfortunately, my doctor’s physician assistant felt I wasn’t compliant when I kept returning to the office with bacterial and yeast problems and actually wrote, “Non-compliant” in my chart. Needless to say, I stopped using it and haven’t been back. I am now 60 years old. I am a pilates instructor of 18 years and love your website and Julie Wiebe’s. In addition, Dr. Bruce Crawford also teaches “Pfilates” here in the States and gives detailed lectures with demonstrations at pilates conferences which I have attended. He’s adamant also about doing the exercises which are very similar to yours and Julie’s. They get the job done and I do recommend them to my clients. I also use them during pilates sessions as part of the routine. Some of my clients request them as they feel the difference! Yes! There is no reason to be embarrassed and to be intimidated by unruly P.A.’s. It’s our body. Thank you for your work and getting this information out there for a more uplifting experience! – S

  4. The physical therapist who oversaw my pelvic floor rehab treatment recommended I remove the pessary during pelvic floor exercises. Do you concur with that advice?

    • Michelle Kenway Physiotherapist says:

      Hi Colleen
      My feeling is that your Physio has recommended your treatment regime based on her understanding of your presentation so she is best positioned to prescribe your rehabilitation. If you have concerns then it would be useful to discuss the rationale for your treatment with her. All the best

  5. Hi Michelle
    I had a baby 8 months ago and have a cystocele and rectocele, which although I have been advised are not severe they have left me plagued with constant heaviness which have left me in a very bad way.I tried 3/4 months of physio doing my kegels but no improvement and have recently had 2 pessery rings fitted. My question is should I expect my symptoms to be just reduced or is it possible to get complete relief if I ask to try a third (larger) or different type of pessery. Many thanks for the support!

    • Michelle Kenway Physiotherapist says:

      Hi Mary
      Different outcomes can be expected from using a pessary – often a good reduction in symptoms from a well fitting pessary that’s appropriate for your prolapse. It’s often worth doing Kegels with the pessary fitted too and the outcomes in terms of symptom relief can take some time. If you’re not satisfied it may be worth trying another size or style. It’s also worth mentioning that the fatigue and heavy work when bub is very young can take its toll on your pelvic floor too, and even more challenging if/while breastfeeding owing to the decreased oestrogen and impact on the pelvic floor. Hope this helps!

      • Many thanks Michelle for your reply! I have another app tomorrow with a urogyne so hopefully he will agree to try another size or type, as am looking forward to feeling like my old self soon! Thank you for providing all of this info it’s been a great comfort

        • Hi Michelle
          I just wanted to update you since my last comment. I had a third ring pessery fitted (75mm), but strangely I have had no improvement in symptoms.
          The only thing that is providing relief are a pair of support shorts I bought online (EVB’s) as they provide a great lift underneath which allow me do any standing related chores around the house, and as a result I am wearing them constantly!
          I am really disheartened the pessery hasnt worked, do you think its possible that my symptoms are due to something else? Or do I need to ask for another size or type?
          I have stage 2 cystocele & stage 2 rectocele. I am due back to see the urogyne in another few weeks.
          Many thanks

          • Michelle Kenway Physiotherapist says:

            Hi Mary
            That’s disappointing for you! I can’t say whether your symptoms are due to something else, that’s up to your gynaecologist to determine and something you need to discuss. Are you seeing a Pelvic Floor Physio to help you? This could help you understand your symptoms much better and know whether an alternative style of pessary might assist along with knowing more about your pelvic floor muscle function. My best suggestion is to seek out a well qualified and experienced Pelvic Floor Physio who can assess your condition and advise and treat accordingly. Hope this helps a little Mary. Always keen to hear how you go, Michelle

  6. Hi there

    Just wondering if you can use multiple pessaries if you have both cystocele and rectocele prolapse?

    • Michelle Kenway Physiotherapist says:

      Hi Lyn
      I don’t see why not – as long as the pessaries give symptomatic relief. This isn’t usual practice though, it’s usually find the best fit and stick with that. Is there some reason for using a variety of pessaries?

  7. Elizabeth says:

    I had a ring pessary fitted about 18 months ago. It is wonderful not to feel a bulge when I stand or walk. It has not helped my slight incontinence; in fact it has made it a little worse. I guess that is because it lifts my bladder, which had fallen low enough that urine could not get out easily. However, I am okay most of the time; sometimes I leak if I jolt or walk when my bladder is full.

    It does not bother my husband when we make love, but I enjoy making love more without it, so sometimes I take it out beforehand. I can get it out easily and in again without too much difficulty.

    One major benefit is that I can do pelvic floor exercises that feel effective now. I worked really hard at them before I had the ring and they didn’t seem to do any good. I think the problem was that I was squeezing on my fallen innards. (One nurse told me to do the exercises lying down or on all fours, which took far more will-power than doing them at any time when I thought about it or was in a public place.) Now, when I squeeze, it feels completely different. I can squeeze much more, because there is nothing in the way, and I think I am getting stronger.