Prolapse and Pessaries: Frequently Asked Questions

Q: Recently I have felt pressure in my vagina and even something that seems to bulge out when I walk around or bear down. Are my insides falling out?

A: Answers from Nancy H. Sullivan, CNM, MS

As women age, the muscles and ligaments that support the pelvic organs can stretch and weaken. When this happens, the pelvic organs drop down from their original position. This condition is called pelvic prolapse. There are five kinds of prolapse:

  • Urethrocele: descent of the lower part of the urethra (bladder opening) into the vagina  
  • Cystocele: descent of the bladder itself into the vagina  
  • Uterine prolapse: descent of the uterus and cervix  
  • Rectocele: protrusion of the rectal wall into the vagina  
  • Enterocele: descent of the small intestine into the vagina (often happens after a woman has her uterus removed, “hysterectomy”)

All of these conditions feel like a “bulge” in the vaginal wall, at the vaginal opening or, in severe cases, protruding out of the vagina. If the vagina and uterus protrude completely outside the body, the prolapse is called “procidentia.”

Prolapse may interfere with normal urinary function. It can cause urgency, frequency, leaking and an uncomfortable feeling of fullness. Surgical procedures can correct these prolapse problems. An effective, nonsurgical solution is a device called a pessary.

Q: My grandmother has a pessary. What is it?

A pessary is a device that is inserted into the vagina to support sagging pelvic organs. By supporting the organs, it relieves the symptoms associated with prolapse.

Pessaries are usually made of latex or polyvinyl. They come in many shapes. The most common ones are round and resemble a diaphragm, although the rim is firmer and the center is open. They also come in cube, donut and U shapes. A properly fitted pessary should cause no pain or discomfort.

Q: How is it used?

Once it is decided that a pessary is the best treatment for a woman, her health care provider (physician, nurse practitioner or midwife) will fit her for the correct size and shape. The practitioner will teach her how to insert and remove the pessary and how often to remove it for cleansing. The practitioner will also give her a prescription for an estrogen cream or lubricant to use with the pessary. If the woman finds it too difficult to remove, clean, and reinsert the pessary herself, she can have this done at the practitioner’s office every four to 12 weeks.

Q: Is it safe?  Is it comfortable?

Complications with pessaries are few and minor. Sometimes it takes several tries to find the pessary of the correct size and shape. If it is the right shape, the right size and correctly inserted, the pessary should not be felt.

A pessary that is too big can irritate the vaginal wall, causing ulcerations and abrasions. If it is the wrong shape or inserted incorrectly, the pessary can put pressure on the urethra, preventing the normal flow of urine. If a pessary causes back pain, foul-smelling discharge or bleeding, the woman should have it checked by her practitioner.

Q: Will a pessary cure the prolapse?

A pessary cannot cure a prolapse. It merely supports the sagging organs and relieves the symptoms. If the pessary is removed, the organs will sag and the symptoms will return. Surgery is the only cure for prolapse. Many women, however, are unable or unwilling to have surgery to correct their prolapse. For these women, the pessary is an excellent alternative.