Pessaries and other non-surgical devices for urogynaecological conditions

Some people we talked to had used vaginal pessaries for prolapse, catheters, or other types of device or equipment to help with urogynaecological symptoms.

This section covers:

  • Finding out about vaginal pessaries
  • Having a pessary fitted
  • Self-removal and ongoing pessary management
  • Using catheters
  • Other non-surgical devices for urogynaecological symptoms

In this section we use the terms:
Pelvic organ prolapse (prolapse) is a condition in which pelvic organs, like the bladder and uterus (sometimes called the womb), move down or slip out of place and may bulge into the vagina.

Urinary incontinence is the unintentional loss of wee/urine. There are other bladder symptoms that do not involve incontinence, such as needing to urinate a lot, getting up at night a lot for a wee, or difficulties emptying the bladder.

UTIs (Urinary Tract Infections) are when bacteria infect the system that stores urine (such as the bladder). There are other types of conditions that can involve bladder irritation and pain, such as interstitial cystitis (also called bladder pain syndrome).

Beverly, a specialist urogynaecology nurse, describes the range of pessaries available and finding a suitable fit

Finding out about vaginal pessaries

Vaginal pessaries are devices inserted into the vagina to support the pelvic organs and can be kept in for up to six months at a time. Pessaries are available in different sizes and shapes. For the people we talked to, it could sometimes take a bit of trial and error in getting the right fit and style. One of the common types of pessary is a plastic ring, but others are made of silicone and different shapes, such as a cone, gehrung, gellhorn, ring with support, or cube.

Cynthia has a ring pessary which was fitted by her GP which works well for her

Phoebe’s physiotherapist had told her about other types of pessaries that are not available on the NHS but can be accessed privately.

Jeannie, Sue Y, and Cynthia had their pessaries fitted by the practice nurse or GP. Cynthia said, “it was such a relief because it sorted out symptoms immediately”. Pauline, and Jacqueline had their pessaries fitted by a specialist urogynaecology nurse at hospital. They go back to the clinic every four or six months to get it checked, cleaned, and refitted.

Jeannie had a ring pessary fitted by the nurse in her general practice. She says “it was a lifesaver because it made such a difference”.

For Amy, Pauline, and Cynthia, finding out about pessaries getting one fitted was quick and easy. But not everyone we spoke to had a straightforward experience. Rose had been discouraged from having one fitted by the doctors she saw. Some found that a ring pessary was available, but getting access to other types of pessary was more complicated. This could be an issue for those with severe or complex prolapses, as shapes other than the ring may be more effective.

Beth felt stuck and frustrated after being told that the only type of pessary she could have fitted on the NHS was a ring pessary.

Some, like Jeannie, felt that their healthcare professionals lacked knowledge about pessaries or hadn’t been trained on how to insert them. Phoebe wondered whether her private doctor over-emphasised surgery in comparison to conservative management options like pessaries. Elly regrets that she wasn’t offered a pessary earlier as she thinks the support may have prevented her prolapse worsening. At times she felt like she was “going round in this big circle” of seeing different practitioners without getting any solutions.

Elly has a silicone ring pessary which she wishes had been offered to her sooner before her prolapse became worse.

For those able and willing to pay, a broader range of pessary options were available to buy or by going private. Phoebe went to a private clinic which offered a greater range of pessaries. Jenny and Rose sought out alternatives to ring pessaries online. Although Jenny tried a sponge pessary and a pelvic floor exerciser, she hasn’t found them very helpful. Kerry had purchased a pessary online that had been recommended to her by her physiotherapist but also found it didn’t help; she thought this might be because she did not have the expertise to insert it properly.

Rose researched non-ring options online after a ring pessary didn’t help.

Amy and Eve saw a healthcare professional privately when they were struggling to get alternatives to ring pessaries fitted under the NHS. Those who did not go private sometimes wondered if their care and range of options might have been better if they had.

Eve chose to go private to access a cube pessary and was pleased with the empathetic care she received.

Having a pessary fitted

A pessary is usually fitted by a nurse or doctor with specialist training. The size and shape of pessary is selected based on the type and grade of prolapse. for Liz, Jan, Sue Y, and others, this took several attempts to get the right size fitted correctly. Elly and Jan both said that their pessary had fallen out as soon as they got home. Liz’s fell out after a day. It took a several attempts by different healthcare practitioners for Mary X to get the right size of pessary.

Jacqueline describes the process of having a pessary inserted. She considered the process to be “painlessly intrusive”.

Jacqueline was given the opportunity to walk around at her appointment to check how it felt. However, Janet felt her appointment had been rushed, and left the hospital worried that the pessaries was not properly fitted.

Janet had a negative experience with having a pessary inserted, she felt dismissed when she raised concerns that it had been inserted wrong and is now put off having a pessary in the future.

Most of the women we spoke to who used pessaries long-term found them to be a suitable treatment option. Jan had found them uncomfortable at first. Jenny had found it extremely painful having the pessary fitted and after getting some advice from a healthcare professional about how it should feel, she decided it wasn’t fitted correctly and went back to her GP practice to have it taken out.

Jeannie and Cynthia noticed increased vaginal discharge. Jeannie and Jenny had bleeding and abrasions and used oestrogen cream for a while to heal the abrasions before they could have the pessary fitted again. Jan noticed there was a smell when it was coming up to the time to have it changed and she felt her “life [was] being dictated by the cone pessary”.

Others did not notice any issues, or considered mild issues worthwhile to get the benefits of the treatment. Jo said she was always aware of her pessary being there and didn’t like this feeling, but felt that it was better than the alternative. Cynthia also looked upon her pessary favourably as it “sorted out symptoms immediately”. Jeannie found having a pessary off-putting at first, but now feels more comfortable.

Many people we talked to with prolapse felt pessaries were a good option to try before considering surgery. For some, it helped manage their symptoms and improve their quality of life. However, Rose, Amy, and Jeannie thought that there would come a point when their pessaries were not enough and they might have to consider surgery, particularly as they got older or if they had more children. You can read more here about experiences of decision-making for treatments.

Self-removal and ongoing pessary management

The upkeep of a pessary usually involves seeing a healthcare professional trained in pessary insertion to have the device removed and cleaned every six months. Jacqueline said this approach “suits her down to the ground” and she was glad that she had tried a pessary before pursuing surgery.

The idea of leaving a pessary in for a long time or having to rely on a healthcare professional to remove it, was unappealing to Vickie and Jenny who had concerns that it might affect their sex lives and personal hygiene. Some preferred to be able to manage the pessary themselves, which meant being able to take out and put back in the pessary themselves. Rose’s doctor was supportive of her self-managing her pessary and explained how to remove it and insert it herself. She takes her pessary out at night.

Vickie’s doctor discouraged her from having a pessary and did not explain the option of self-management where she could take it out when having sex.

Jenny worries about hygiene and infection risk, so she prefers to self-manage and clean her pessary regularly.

Over time, pessaries may need to be changed to different sizes or shapes, as women’s bodies change. Jeannie has been managing her prolapse since menopause with a ring pessary but now thinks she needs another shape of pessary.

Using urinary catheters

Catheters are made up of an insertion device, tube, and a drainage bag. Some people we talked to had catheters temporarily fitted during medical tests or surgeries. Others used catheters on a regular basis, with styles that can be self-inserted. Minnie used a catheter to ensure that her bladder was fully emptied as she struggled with retaining wee, needing to go to the toilet a lot, and leaks. Catheters can also be left in place, as in the case with indwelling urinary catheters or suprapubic catheters inserted through the abdomen.

Learning to use and manage a catheter can be confusing and feel overwhelming. Following problems after mesh surgery, Fran felt “really distraught” at the idea of self-catheterising and was uncomfortable when she thought there was no option. Leeanne, who is mesh injured, looked more favourably on catheters as she has got used to inserting them. She described the type of catheter she uses as a “smashing little device” and appreciates that they are discreet for carrying around in public.

Leeanne now finds self-catheterising very convenient and appreciates the flexibility it gives her when she leaves the house.

Jamie was struck by the lack of information given to her when she left the hospital. She learned more about self-managing over time and found it particularly helpful to join a support group for those with bowel and bladder problems. The period of adjusting to self-catheterising was less stressful for Minnie, who was taken through the steps of catheter insertion before leaving the hospital.

Some people, like Mary Y and Sian, struggled with pain, bleeding, and more frequent infections related to using a catheter. Elizabeth was particularly concerned that catheterising could increase her risk of bladder lesions and ultimately chose not to use a catheter. Mary Y found it upsetting if her catheter bag was visible to others and told us that it caused a “horrible feeling” of physically pulling down on her stomach.

Fran tried her best to empty her bladder fully, but continued to get infections. She felt that her doctors assumed she was doing something wrong.

Mary Y’s catheter caused her emotional and physical discomfort, which was improved by finding a style of device that worked better for her.

For those with additional health concerns, catheterising could be especially difficult. Jamie has a degenerative spinal disease which makes it difficult to self-catheterise. She has tried indwelling and suprapubic catheters, but had problems with pain and infection. Sian also had to adapt how she uses catheters, as she has mobility limitations from a herniated diaphragm (a hole in the diaphragm, a muscle which separates the chest from the abdomen). For more on catheters see our website on Living with a urinary catheter.

Other non-surgical devices for urogynaecological symptoms

The devices we heard about included pelvic floor exercisers, TENS machines (nerve stimulation devices for pain relief), and devices to assist with weeing while standing. These devices could be accessed through NHS services or bought online or from a shop. Freia was struck by how some devices cost “quite a lot of money” which was also a concern for Rosie and others who were doubtful if the devices would work.

Freia has purchased cycling shorts with nerve stimulation that are advertised for people with incontinence. She struggles with feeling “guilty” about not using the device regularly.

Devices to exercise and strengthen the pelvic floor to manage prolapse or incontinence were sometimes referred to as Kegel machines, pelvic floor exercisers, or pelvic floor trainers. Rosie’s physiotherapist recommended vaginal weights to help prevent her incontinence issues from getting worse during her pregnancy. She wasn’t sure if these would work for her, and thought they sounded “terrifying”. Some types of pelvic floor devices link to a phone app or handheld device to give a reading on pelvic floor strength.

Mary X was loaned a pelvic floor trainer by her physiotherapist. After testing it out, she chose not to buy one for herself one because she wasn’t sure it worked.

Jenni, Jenny, and Iris used pelvic floor exercisers, but weren’t sure how effective they were. Jenny bought a pelvic floor trainer online which gave her feedback on how well she was doing the exercises and included weights which she could increase over time. Though she has seen an improvement with her urinary incontinence, she wasn’t sure if it was really related to the machine. Iris received an electrical pelvic floor trainer from her hospital’s incontinence nurse. She tested it out, but suspected that it was “probably not doing anything”.

Jenni started using a Kegel machine at the recommendation of her physiotherapist. Her incontinence symptoms have improved, but she isn’t sure whether this is because of her long-term cough resolving or the device.

Minnie, who has urinary incontinence, bought a device that lets her urinate standing up and makes it easier to wee on the go. You can read more about incontinence pads here.

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