What is a prolapse?
Prolapse happens when there is a weakness in the tissues and muscles that help support your pelvic floor. When these tissues weaken the structures of the pelvis can drop down and be seen or felt at the vaginal opening.
The structures of the pelvis are one or more of the following:
You may feel a bulge inside your vagina or at the opening of the vagina.
What can cause a prolapse?
Many things may put you at risk for prolapse. Often there is not just one thing that causes prolapse.
- Prior pelvic surgery
- Pregnancy and vaginal childbirth
- Intense physical activity/lifting heavy objects
- Being overweight or obese
- Frequent constipation or straining to have a bowel movement
- Chronic coughing
- Genetic disposition
What are symptoms of a prolapse?
Many people have no symptoms and are not bothered by their prolapse. Other people may have very mild to more severe symptoms. Talk with your provider if you have symptoms that bother you.
Some of these may be:
- Feeling of pelvic heaviness or fullness
- Bulging in your vagina
- Bulging at the opening or outside your vagina
- Lower back pain or pressure
- Leakage of urine (incontinence)
- Sexual difficulties
- Problems inserting tampons or applicators
What is a pessary?
It is a device that is placed up in your vagina to help support the walls of your vagina, bladder, and urethra. It can be used to treat SUI.
Pessaries come in many shapes and sizes. Your provider will:
- Talk with you about the type that will work best for you
- Fit you with the correct pessary
- Teach you how to care for it
How to place the pessary
- Moisten the pessary with water or a small amount of lubricant.
- Fold it with the dominant hand (the hand you use the most)
- While sitting or standing, spread your labia with your non-dominant hand (your other hand).
- Gently put the folded pessary into the vagina.
- When it is halfway into the vagina, while you are still holding the folded pessary, move your non-dominant hand to help guide and push it into the vagina.
- After it is in the vagina and you let go, it will unfold.
- Gently push it back as far as it can go. You cannot push it back too far.
- It should not cause discomfort while in place.
Some pessaries do not fold. Your provider will show you how to put in this pessary.
If your provider wants you to use vaginal estrogen, you can do one of two things:
- Put estrogen cream or estrogen tablet into the vagina at night after taking out the pessary. You often do this 2 times per week.
- Use 2 pea sized dabs of estrogen cream when you put in your pessary.
How do I manage the pessary?
Take it out and leave it out at night at least 1 time a week. Some people take it out nightly. Then they put it in the next morning.
To remove the pessary:
- Place your index finger and thumb into vagina and get a hold of it. You may need to bear down to get a hold of it.
- Gently pull it out.
- Clean it with mild soap and water. Let it air dry.
- Check it for:
- Changes in color
Additional general questions
If the pessary comes out, you may reinsert it.
- This may happen with a bowel movement.
- Do not flush it.
If the pessary is uncomfortable, you may take it out.
- You can reinsert it right away or leave it out for hours.
- Remember to push the pessary back as far as you can get it. You cannot push it in too far.
Most devices are uncomfortable if left in place during sexual activity.
It is best to remove it unless told differently.
Vaginal discharge is very common when using a pessary.
When should I call the clinic?
Call to be seen if you have:
- Chills and/or fever over 100.4° F (or 38° C)
- Vaginal pain
- Bloody discharge when removing pessary
- Foul smelling vaginal discharge
- Continued irritation from the pessary
- Any vaginal bleeding not related to your period
- Tears, cracks or changes in the color of the pessary
- If you cannot get the pessary in or out
- This is not an emergency, call the clinic when it is open.
- If you lose the pessary