This is a guest post by my very own pelvic floor physiotherapist, Mercedes Eustergerling. Find her in Calgary at Vida Health
If you’ve delivered a child vaginally, you may be familiar with the number one fear of a postpartum woman: the first poop.
Your body sends you a signal that you need to go to the bathroom, but a part of your brain starts to calculate how long you can survive without having a bowel movement. (A day? Two? I think I read a story about a woman who didn’t poop for two weeks … I wonder how she’s doing.)
Inevitably, your brain loses the battle, and you go and sit down. You feel pressure, heaviness, weakness and uneasiness. As you push, you may even feel like your insides are going to fall out. This is all very normal and expected in the first hours after childbirth. As your body recovers, you regain the strength, and things go back to normal.
For some women, though, those feelings of pressure and organs falling can continue. They may leak urine, have pain with intercourse or see or feel a bulge within the vagina. These women have a pelvic organ prolapse, and they often seek help from pelvic physiotherapists to reduce their symptoms.
Pelvic organ prolapse happens when one of the pelvic organs (bladder/urethra, uterus or rectum) moves toward the vaginal canal and encroaches on it, creating a bulge. The bladder pushes against the vaginal walls from the front; the uterus and rectum come from the top and back, respectively. About 50% of postpartum women have a prolapse, but not all are symptomatic. Health professionals can describe the extent of the prolapse by grading each one from Grade 1 to Grade 4, depending on how far the organ has travelled relative to the opening of the vagina (called the introitus).
Physiotherapy can be very helpful in reducing the symptoms of pelvic organ prolapse. Through strengthening, motor patterning and a toolbox full of other interventions, pelvic health physiotherapists work with women every day to recover from childbirth, surgery and trauma.
Sometimes, physiotherapy and strengthening are not enough to reduce the symptoms of a pelvic organ prolapse. A woman may continue to have difficulties with physical activity, long days on her feet, a full work shift or everyday life. This is when we start to look at what other options are available. She may be a surgical candidate and need a referral to a urogynecologist. (This is a topic for another day since I am not a surgeon and can’t comment on what those criteria are.)
A non-invasive option is to use a pessary. A pessary is a silicone device that sits inside the vaginal canal and supports the pelvic organs. It can stay in for up to a few months, but most of them will be removed and cleaned by the woman on a regular basis. The pessary can be used all day long or only for specific activities.
Women already have a large amount of variability in their pelvic anatomy, and when things start to shift, the permutations and combinations only increase. Pessaries come in many shapes and sizes to allow for a customized fit. They have one of two basic functions with some additional features:
1- Support the pelvic organs and keep them in place. A typical pessary of this type is the ring pessary.
2- Occupy space within the vaginal canal so the pelvic organ is not able to encroach. A typical pessary of this type is the cube pessary.
Additional features include extra support, a urethral knob for incontinence and a stem to prevent rotation.
The process for being assessed and fitted for a pessary will vary from place to place. In Canada, urogynecologists and outpatient hospital clinics may provide the service. Wait times depend on the location, demand and staff availability. Physiotherapists in most provinces are able to do pessary fittings if they have undertaken advanced training. Because of this, access is improving across the country. Pessaries are starting to be seen as a tool for quality of life improvements—similar to a menstrual cup—as women learn more about their bodies and how to manage postpartum recovery.
Frequently Asked Questions
Does it hurt?
A properly fitting pessary can’t be felt once it’s inserted. It should be like putting on your clothes in the morning: at first you notice them on your skin, but moments later you forget all about them.
I haven’t done pelvic physiotherapy. Can I get a pessary?
Good healthcare is all about minimal interventions. If you can manage your symptoms without using a device, that should be the first approach. It’s important to do pelvic physiotherapy before trying a pessary.
I haven’t had children. Why would I use a pessary?
There are many things that can contribute to a pelvic organ prolapse and childbirth is simply the most common. The pessary is used to manage symptoms regardless of their cause.
Is it covered by health insurance?
In Canada, a pessary fitting that is done by a physician or within the public system will likely be covered under provincial healthcare. (Actual coverage may vary by location—call ahead to check.) Pessary fittings done by a physiotherapist can be submitted to your extended health benefit plan for regular physiotherapy coverage.
Can I have intercourse or my period with a pessary inserted?
Many pessary shapes can be worn during intercourse since they don’t interfere. Some women choose to remove the device for a variety of reasons. It does need to be removed for menstruation.
Can I use my menstrual cup to do the same thing?
The menstrual cup is designed to collect fluids and doesn’t allow for the passage of normal, healthy discharge. There may be safety issues with prolonged use, and the manufacturers recommend regular removal and cleaning that is more frequent than a pessary.
Additionally, the menstrual cup is not shaped to support the pelvic organs. Some women with pelvic organ prolapse are unable to keep a menstrual cup in place for this reason.
What if I have more questions or want more information?
Please contact Mercedes in Calgary to discuss anything related to pelvic health and physiotherapy. Talk to your local pelvic health clinic, women’s health clinic or gynecologist for a referral outside of YYC!
Mercedes Eustergerling is a physiotherapist and lactation consultant in Calgary, Alberta. She is the founder of Vida Health & Wellness, where she provides no-nonsense, evidence-based physiotherapy that simply works. Mercedes thrives on helping women with chronic conditions and complex health histories who have tried everything else.