I have some pretty special days in my job. One of the really brilliant ones happened the other day when a beaming patient marched in and when I asked her how she was she said “Fantastic and thank you very much”. Now we aren’t allowed to have testimonials or self-promoting type things on our blogs or websites but I am writing this to let patients know about the value of pessaries in prolapse management and also I am writing it on behalf of all the pelvic floor physiotherapists who day in and day out help women with prolapse, through some pretty easy lifestyle advice AND importantly, the use of some type of pessary.
Pessaries are an invaluable tool in the management of prolapse.
Let me say it again: Pessaries are an invaluable tool in the management of prolapse!
And this is regardless of the age of the patient. In fact, using a pessary with a younger woman who wants to more vigorously exercise can be a ‘mood saver’ for her. Many women come to me and say ‘I get so depressed when I can’t run’ and putting in a pessary, even just for the exercise session, can give the necessary support to allow that running to happen.
But back to my brilliant day when MJ walked in and made my day. MJ was SO ecstatic that she offered to write a blog telling of her journey. And this is not me just being lazy. Patients love patient stories. They can relate to them in a very personal way. So here is MJ’s story.
I start by saying “thank-you Sue”. (And all the other pelvic floor Physios of the world – called #pelvicmafia- I’ve written that).
I’m 67 years. After living with a prolapse for several years, approximately 11 years ago I sought advice from a specialist who more or less told me to just keep on living with it – no treatment was given at that time. From then were years of feeling exhaustion, pressure and bulging from my vagina – particularly in the afternoons. I must say I was feeling pretty miserable when, end of last year my GP suggested I see a specialist again in case surgery was needed.
A chance remark from a colleague late last year made me check out Sue’s website, I made an appointment and I first met Sue early this year.
From my first meeting with her I felt confident. She explained the damage to my muscle walls and the need to strengthen these through bracing – for life, irrespective of whether or not surgery was required. Because my vagina is dry I am now using Vagifem (local oestrogen) twice weekly. Sue is the first person to examine my pelvis whilst I was standing and so she could feel the bulge.
Constipation has also been a longstanding problem for me and she put me on track to focus drinking plenty of fluids, taking Benefibre or similar, using some toilet rolls to get elevation of the feet and bulging the top of my stomach to my waist with defaecation (the bulging felt very strange and was difficult for a few weeks but I persisted and did get the hang of it) rather than pushing down or straining into my bottom.
On my second visit to see Sue she confirmed that my walls were strengthening. We discussed keeping going with exercises, water etc and discussed options – ring pessaries or surgery. I did go to a urogynaecologist who was very helpful, organised some tests and advised me that I had the option of surgery or ring pessary.
So here we are, end of May. I’ve just seen her again and told her I decided that surgery would be my last option so have been using the ring pessary. I can’t believe the difference it has made – the ring pessary is comfortable and has lifted up the prolapse, I don’t have pressure, I can’t feel a bulge, I’m not exhausted, I feel liberated.
It seems incredible to me that this turnaround has happened in less than 6 months -however I will not be complacent – it’s doing my pelvic floor exercises regularly (in lying down, sitting, standing), but always balancing the tightening with some relaxing and letting go with my tummy and pelvic floor; and bracing whilst sneezing, coughing, exerting pressure – for life! Thankyou.
Thanks MJ for making my day and well done for grabbing the advice and running with it.
Now some cautionary words.
Pessaries come in two styles- a quite rigid one, inserted by a gynaecologist/ uro-gynaecologist that stays in for around 4-5 months and then gets taken out, washed, the vagina is inspected and then it is re-inserted for another extended period of time. The second style- the ones that Women’s Health Physios pop in- are more flexible, stay in for a maximum of 7 days and the patients are taught how to self manage them. It is important to be using local oestrogen with either type and you need to see your GP or specialist once a year to get the vaginal walls checked for any erosion from the pessary.
If you have significant levator avulsion then it may be difficult to fit a pessary as it may keep falling out.
1. Images are taken from Sayco website