How Many Years Can You Use a Pessary?
A pessary is a silicone support device worn in the vagina to manage symptoms of pelvic organ prolapse, a condition where weakened muscles and ligaments allow a pelvic organ to sit lower than it should. It works by lifting the organs so the pelvic floor muscles and ligaments have a chance to strengthen and shorten.
How long you need a pessary varies widely, from six months for mild symptoms to ongoing use for more severe cases. Factors like how long you have had symptoms, the type of prolapse, your muscle strength, and your age all shape the timeline.
Over time, many patients regain enough strength and support to reduce the size of their pessary or stop using it altogether. Working with a pelvic floor physical therapist trained in pessary fitting can help you reach that goal.
What a Pessary Is and Why It's Used
A pessary is a silicone support structure that sits in the vagina to help to manage symptoms of pelvic organ prolapse.
Pelvic organ prolapse is a condition in which the pelvic ligaments and pelvic floor muscles have become over lengthened which causes in one of the pelvic organs (bowel, bladder, uterus, or urethra) to sit lower in the pelvis.
Symptoms of pelvic organ prolapse include: heaviness, pelvic pressure, and bowel and bladder changes like difficulty passing urine or stool.
Prolapse can occur due to the result of childbirth, prolonged coughing and lifting, or even due to conditions that affect ligament support, such as Ehlers dances syndrome.
Pelvic organ prolapse occurs due to a loss of pelvic muscle and ligament support. A pessary helps to lift the organs so that the pelvic floor muscles and ligaments can get stronger.
How Long Pessaries Are Typically Used
Pessaries can be used short-term or long-term. In patients with mild symptoms, the wear time could be 6 months to a year. In patients with moderate or severe symptoms, the wear time could be 2 years+, or even forever.
Depending on the type of pessary, you may be need to put it in and take it out every day, while others could be worn for a couple of months at a time.
Factors that Affect How Long You'll Need a Pessary
The goal of the pessary is to increase the strength of the muscles and to shorten the pelvic ligaments.
The factors that affect how long you’ll need a pessary include:
How long you’ve been dealing with symptoms. Typically, the “newer” your symptoms, the less you should have to wear it. As prolapse gets more chronic, muscle and ligament damage progresses. Having a prolapse for a number of years can therefore increase wear time.
What type of prolapse you have. Some types of prolapse respond better to pessary use while others (like a low lying rectocele) do not.
Your history of prolapse including what it is the result from (traumatic lifting incident vs got worse with time). If your prolapse is the result of a traumatic lifting incident (you feel a pop and then started feeling symptoms) the chances of weaning out of a pessary are limited. Traumatic lifting injuries usually result in ligament tears, whereas prolapse that gets worse with time is typically the result of ligament stretching. Ligament stretching responds very well to pessary use.
Whether you have pelvic floor muscle damage, and what your pelvic floor muscle strength is. Ring pessaries rely on good muscle support in order to keep them in place. When the pelvic floor is damages or severely weak, the ability to wear a ring pessary is limited. There are other types of pessaries that are more appropriate, but it will likely take many years to improve muscle strength to the point that you will be able to wean out of the pessary
Your age and hormone status (pregnant, postpartum, breastfeeding status, peri or post menopause). Typically, the older you are, the more likely the chances are that you will need prolonged pessary use. As we age, especially in a low hormone state, we have less ability to form muscle mass and we lose pelvic floor muscle strength rapidly as we age. Since the goal of pessary use is to shorten ligaments and increase the strength of the pelvic floor muscles, elderly patients may need long term pessary use.
Your desire to wear it. If you don’t want to wear it, or get tired of wearing it, we understand! It might not be for you, and you might want to stop wearing it!
What Changes Over Time With Pessary Use
Over time, we can expect the pelvic floor muscles to heal, the space where the pelvic floor muscles open (called the levator hiatus) to get narrower, and the ligaments supporting the prolapsed organ to shorten.
This then takes pressure off of the pelvic floor muscles, making strengthening more effective.
If we are able to get better strength, better pelvic floor muscle coordination, improved support from the ligaments, and improved ability to use your core without bearing down, we could decrease the size needed of the pessary or even get rid of it completely.
Pessary use is part of a multimodal approach to improve pelvic floor function. It’s important that even those that wear a pessary still participate in a strength training regimen.
When It Might Be Time to Reassess Your Options
If you have done all of the pelvic floor muscle training, worked with a skilled pelvic floor PT who is not trained in pessary use, without result, it might be time to try something different.
Working with a pelvic PT trained in pessary fitting might help you get rid of your heaviness, pressure, and leakage for good.
Where to Find Pessary Fitting in Bucks County
Vivid Women’s Health is a women’s health physical therapy practice with two locations. We have one in Newtown, PA and one in Doylestown, PA. We provide unmatched pelvic floor physical therapy to help women resolve pelvic floor symptoms.
If you are local to the Newtown, PA or Doylestown, PA, Bucks County area, please click here to find out more about our in person services. If you are visiting our site from afar, we offer virtual services to help you overcome your pelvic health concerns. For virtual pelvic floor care, please click here.
We proudly put our patients first by offering one-on-one appointments for a full hour. You will have time to be heard and we will take time to listen to your whole story.
You won’t be passed between different professionals and we will work to get you a holistic solution to your pelvic health concerns.
We choose to participate in a private pay model so that we can focus on putting patients first.
We'd love to help you with pessary support. Feel free to contact us or book online today.
