Pessaries & their Role in Pelvic Floor Physical Therapy

by Dr. Angie Maxwell, PT, DPT, WCS. Owner & Lead PT of Madrona Physical Therapy.

Pelvic floor physical therapy (PFPT) is integral in treating a variety of pelvic health conditions, from urinary incontinence to pelvic organ prolapse (POP). One tool that can aid in these treatments is a pessary—a small, flexible device inserted into the vagina to provide support for the pelvic organs. In this blog post, we'll explore how pessaries are used in pelvic floor physical therapy and the benefits they offer to individuals experiencing pelvic health issues.

A pelvic floor physical therapist can determine from their initial evaluation whether or not a patient is a candidate for a pessary. If they are a candidate, the pelvic floor physical therapist will perform a separate assessment to fit the pessary.  During this assessment, there is a more detailed examination of the pelvic floor musculature and the position of the pelvic organs and this is how the size and shape of the pessary is determined. A properly fit pessary can often play a vital role in helping patients succeed in their treatment plan!

How Pessaries and Pelvic Floor Physical Therapy Improve Patient Quality of Life

In pelvic floor physical therapy, pessaries are not used as a stand-alone treatment but as part of a comprehensive approach to managing pelvic health issues. Here's how they are typically integrated:

1. Providing Immediate Symptom Relief
One of the key ways a pessary is used in pelvic floor physical therapy is by providing immediate relief from symptoms associated with prolapse. For example, a pessary can reduce pressure on the bladder or uterus, which can decrease symptoms such as pelvic heaviness, urinary leakage, difficulty emptying the bladder or rectum. This relief allows patients to feel more comfortable, especially when engaging in activities like walking or exercising, which may have been previously restricted due to symptoms.

2. Supporting Pelvic Floor Rehabilitation
Pelvic floor therapy aims to strengthen and retrain the muscles and tissues that support the pelvic organs. In cases where pelvic floor muscles are weak or damaged, a pessary can provide external support to reduce the load on the pelvic muscles. This support gives the muscles time to heal and regain strength without the added strain of supporting the prolapsed organs on their own. This enables the pelvic floor muscles to work more efficiently during exercises, allowing patients to focus on strengthening the pelvic floor without worrying about further prolapse or symptoms.

3. Enhancing Pelvic Floor Exercises
When pelvic floor physical therapists design exercise plans, they often incorporate different techniques to improve muscle tone, coordination, and function. For some individuals, doing pelvic floor exercises may be difficult or less effective without added support. A pessary can act as an adjunct, allowing the patient to perform these exercises more comfortably and effectively.

Additionally, a pessary can provide support while training for more vigorous exercises or movements, such as jumping or running, that might otherwise trigger leakage or discomfort. With the right pessary, patients can engage more fully in their physical therapy exercises, leading to faster improvement.

4. Enhancing the Recovery Process
Over time, pelvic floor physical therapy aims to improve the strength and function of the pelvic muscles. However, this process can take time. A pessary may serve as a temporary support while therapy works to strengthen and rehabilitate the pelvic floor. This is especially helpful for individuals who experience difficulty engaging in physical activities due to prolapse or incontinence, allowing them to maintain a more active lifestyle during their recovery. In some cases, after the pelvic floor muscles are rehabilitated the pessary may no longer be needed.

5. Helping to Change Movement Patterns and Lifestyle Modifications
Pelvic floor physical therapy often includes recommendations for lifestyle changes, such as improving posture, avoiding heavy lifting, or modifying daily activities that could exacerbate symptoms. Pessaries can act as a supportive tool during these adjustments, allowing patients to transition to new habits with more confidence. For example, a patient might be instructed to avoid lifting heavy objects to reduce strain on the pelvic floor, but the pessary can help alleviate pressure during necessary tasks.

The Role of the Pelvic Floor Physical Therapist and Pessaries

While pessaries can be very effective, they are not "one-size-fits-all”. Pelvic floor physical therapists select the right type of pessary, teaching patients how to insert and remove it, and ensuring it is comfortable and properly positioned. Additionally, the therapist will monitor the patient's progress, adjust the pessary as needed, and incorporate it into the overall rehabilitation plan.

Pessaries are one tool that a pelvic health physical therapist may use to help patients recover. During therapy, a pelvic floor physical therapist will teach the patient how to perform exercises that will help strengthen the pelvic floor muscles and improve the coordination of these muscles with the pessary. They will also provide education on lifestyle changes, improve daily movement patterns, address posture issues, improve breathing techniques, and enhance core engagement to promote overall pelvic health.

Benefits of Using a Pessary in Pelvic Floor Physical Therapy

Using a pessary as part of pelvic floor physical therapy has several benefits, including:

• Symptom management: Pessaries can reduce discomfort and prevent the worsening of symptoms associated with prolapse and incontinence.

• Improved muscle function: With external support, the pelvic floor muscles can work more efficiently during therapy, speeding up the healing process.

• Non-surgical treatment: Pessaries offer a non-invasive option for managing pelvic floor disorders, particularly when surgery may not be desired or necessary.

• Enhanced quality of life: By providing support and symptom relief, a pessary can help patients maintain an active lifestyle and reduce the impact of pelvic floor conditions on their daily activities.

Pessary use may be beneficial to many patients during pelvic floor physical therapy, offering patients relief from symptoms of pelvic organ prolapse while allowing for effective rehabilitation of the pelvic floor muscles!

When used in combination with targeted exercises and lifestyle modifications, a pessary can help improve quality of life, reduce symptoms, and promote long-term pelvic health.

If you’re experiencing vaginal heaviness, urinary leakage, difficulty emptying the bowel/bladder, or other symptoms of prolapse, consider speaking with a pelvic floor physical therapist to determine if a pessary could enhance your individual treatment plan.