Living with a pessary gets much easier once you get used to it. People often ask us – How do I look after it? How often does it come out? What’s normal, and when should I call someone? This post answers those questions. If you’re still deciding whether a pessary is right for you, start with our first post, Pessary for Prolapse: What It Is, How It’s Fitted and Who It Suits.
Most women find a pessary becomes a simple part of their routine within a few weeks, and it’s much less daunting than it first sounds. When we fit one, we provide advice and a handout for you on how to manage it, and you can always give us a call if you have further questions.
Living with a pessary: How often does it come out?
We teach you how to insert and remove your pessary yourself, so you can manage it at home. How often it comes out depends on the type:
- Cube pessary: taken out every night and put back in the next morning.
- Other pessaries (e.g. ring, Gellhorn, ring with knob): can stay in for around two weeks at a time, then are taken out, cleaned and put back.
Taking your pessary out regularly lets you clean it and gives the vaginal walls a rest. It’s also how you’ll notice early if anything needs attention, such as a sore spot or a bit of blood.
How to clean your pessary
- Wash it in warm water with a mild, unperfumed soap, then rinse it well and leave it out to dry overnight
- Don’t use chemicals to sterilise it – if you need to (e.g. it falls in the toilet) you can boil it for 10 minutes
- Check it each time after you wash it. Some discolouration is common and nothing to worry about, but cracks or rough patches mean it’s time for a replacement.
Pessaries wear out over time, usually after a year or two. We’ll let you know when yours needs replacing.
Check-ups when living with a pessary
Even if you manage your pessary yourself, regular check-ups with us are important. We will examine the vaginal walls for any signs of rubbing, make sure the fit is still right and answer any questions. Guidelines suggest a check at least every six months, and some people need to be seen more often. We’ll tell you what’s right for you.
Check-ups are also a good time to see how your pelvic floor muscle training is going. Some people find their symptoms improve enough that they can try managing without a pessary.
What’s normal when living with a pessary?
A successful pessary fitting means it reduces your prolapse symptoms, and you’re not aware of it when using it. Some people notice a little more vaginal discharge than usual. Occasionally the pessary can cause bladder leakage. This is usually because the pessary reveals a leak that was already there, rather than the pessary causing it. It can be treated, so let us know.
When to get in touch
Contact us or your GP within a few days if you have:
- lots of discharge with an unpleasant smell
- any bleeding or spotting. Bleeding after menopause should always be checked by a doctor
- soreness, pain or a pessary that feels uncomfortable
- a pessary that keeps slipping or falls out
- new onset bladder leakage
- difficulty having a bowel motion
- difficulty getting the pessary out
Get help the same day if you can’t pass urine, or have severe pain, or you feel unwell with a fever or a smelly discharge. Contact your GP or an urgent care centre, or go to the emergency department.
If your pessary falls out, don’t panic. Call us and we’ll refit it, sometimes in a different size or type. If you can’t remove it, don’t force it. Contact us and we will arrange a time for you to come in so that we can take it out for you.
Vaginal oestrogen
After menopause, the vaginal tissue becomes thinner and drier, which makes it more prone to irritation, rubbing and infection when a pessary is in place. Low-dose vaginal oestrogen (Ovestin), available as a cream or pessary, helps keep the tissue healthy. It is absorbed locally, so only a very small amount enters the bloodstream.
There’s a big drop in oestrogen after childbirth, which makes the vaginal tissue thinner and more prone to erosion with a pessary, so Ovestin is often used then if we are recommending pessary use.
Ovestin is prescribed by your doctor, and we’re happy to write to your GP if we think it would help.
Sex, exercise and daily life
Living with a pessary doesn’t mean giving up the things you enjoy.
- Sex: with some types, such as the ring, you can have sex with the pessary in if you want to. Other types need to be removed first. We’ll tell you what applies to your pessary.
- Exercise: most activities, including walking, swimming, dancing and gardening, are fine once the pessary fits well. If you do high-impact exercise or heavy lifting, the pessary will help support the pelvic organs.
- Pelvic floor exercises: keep doing them with the pessary in. They help your symptoms and can reduce how much you rely on the pessary.
- Constipation: straining can push a pessary out of position, so keep your bowel motions soft and regular. Drink plenty of fluids, eat enough fibre, and ask us about toileting techniques that support the area when you open your bowel.
Frequently asked questions
Why does the pessary need to come out regularly?
It lets you clean it, check it and rest the vaginal walls. A pessary left in for too long can cause sore areas, discharge and occasionally more serious problems. Regular removal is the best way to avoid that.
What if I can’t get the pessary out?
Don’t force it. Contact us or your GP promptly and we’ll remove it for you. If you’re having trouble every time, we can go over the technique together or try a different size or type.
Will a pessary make me leak?
Not usually. When women leak more after fitting, it’s most often a leak that was already there and has become more noticeable. Tell us, because there are pessaries that help prevent bladder leakage as well as support a prolapse.
Do I still need to do pelvic floor exercises?
Yes. A pessary supports your pelvic organs, but it doesn’t strengthen your muscles. Doing both gives you the best results.
Will I need a pessary forever?
Not necessarily. Some women use one for a short time, others for many years. We’ll review how you’re going at your check-ups.
Do I need a referral?
No. You can book directly with our clinic without a referral.
Need help with your pessary? Four of our specialised pelvic floor physiotherapists are experienced in fitting and managing pessaries. We can fit one, teach you to manage it yourself, and review how it’s going. Book an appointment. No referral needed.
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