Written by Anna Geraets, Physiotherapist, Pilates Instructor and Women's Health Specialist

What are these and how do they work?

A pessary is a device used for a number of gynaecological problems. They are used frequently by gynaecologists, continence nurses, or pelvic health physiotherapists. At Auckland Physiotherapy we use pessaries to either support a prolapse or assist with incontinence.

So, why a pessary?

Sometimes there has been an overstretching of the structures that support the vagina. This can be from birthing a child, or from more chronic conditions such as constipation, COPD, or other causes of repetitive strain on the pelvic floor.

This overstretching can cause “prolapse”, where there is a movement of the vaginal walls into the vagina, or difficulty in closing off the urethra when you want to stop urine from passing through, such as on coughing or sneezing. These can cause symptoms such as heaviness, dragging, or deep backache, the sensation of “something there”, bladder difficulties with incontinence or leaking or urgency, or difficulty in passing bowels. This can be all the time or just with particular exercise or activities, such as running or lifting weights.

Pessaries are an effective tool for managing these concerns. They are an internal support to the vaginal walls and can help with the closure of the urethra. The pessaries we work with are made of medical-grade silicone and come in a vast variety of shapes and sizes for all sorts of presentations and symptoms. We will identify that a pessary might be useful during your initial or subsequent appointments.

We use fitting kits to help us choose the correct pessary to ensure it is comfortable and provides adequate support to the areas of concern.

A pessary can be self-managed, where we teach you to insert and remove the device yourself. This is particularly helpful when the pessary is only needed for a particular sport or activity, and a woman can choose to use it just during these tasks. It can also be managed by your physio, in which case you will need to come in every three months to have it checked. The pessary itself lasts a year (under manufacturing guarantee), and needs to be replaced annually.

If you were self-managing your pessary, you would need to come in for a fitting appointment, a review at two weeks, a review at 3-6 months, and an annual review. Usually, though, a pessary is an adjunct to physiotherapy and it is more likely you will be working with your physio on pelvic floor exercises and other areas of rehabilitation such as retraining your bladder.

The decision to use a pessary is really up to you. They are a great option, but not the only option in management. Sometimes a woman may be waiting for surgery and just buying time (e.g. those anticipating more children in the coming years), or perhaps wanting to avoid surgery altogether. Sometimes we use a pessary for the first postnatal year while working on rehabilitation and during the postnatal recovery period.

There are very few contraindications to the use of a pessary; active infections of the vagina (e.g. pelvic inflammatory disease), patients who are unable to manage their pessary (e.g. won't attend follow up appointments), or an allergy to silicone are the few situations in which we would not fit a pessary when one is indicated.

Compiled by our Director, Senior Physiotherapist and Pilates Instructor Helen Dudley. To book an appointment with Helen, or read her Meet the Team profile CLICK HERE.

Incontinence is the involuntary loss of urine at an inappropriate time or place. For a lot of us, incontinence can be an everyday occurrence that puts strain on our mental health and can limit our physical activities and enjoyment. This taboo problem is unfortunately all too common so if you do experience incontinence, whether it is a few drops every now and then to full bladder leakage, you’re not alone. In fact;
- 1 in 3 women have some degree of urinary incontinence
- In women 45-60 years old, this number increases to 50%
- 13% of men have urinary incontinence

As Physios, we obviously advocate the assessment and rehabilitation of incontinence issues with a Pelvic Health Physiotherapist, especially as the research is so propelling as to the success of treatment. In fact, 70% of women with incontinence will get significant improvements with appropriate treatment.

In saying that, we also understand that it can be very debilitating to every day life so management is just as important to enable you to live well and do the things you love. In the past, this has meant using pads that are uncomfortable and not environmentally sound. That is why we were so excited and had to share this great new product with you.

Awwa is a great NZ female founded company that provides pee-proof pants for people of all shapes and sizes. They have a great ethos; making sustainable and climate positive products that are made of natural, organic and recycled fabrics. The pee-proof underwear wicks moisture away from the body and locks it into the centre layer, meaning you feel dry and smell fresh all day long.

Here is more information taken from their website:

How Does AWWA work for bladder leakage?

Our innovative hi tech layers have been developed especially to absord fluid but keep you dry and fresh.
1 - The top layer, sits closest to your skin and wicks moisture away fast and keeps you feeling dry.
2 - An antimicrobial layer that fights odours and bacteria
3 - A super absorbent layer that safely holds 18 ml of fluid (that you do NOT feel)
4 - Bottom layer, is a leak proof barrier

Do they smell?

Our high tech layers mean that all liquid and odour are locked in the middle layer so there’s no smell.

Do you feel wet wearing them?

Absolutely not!

How long can you wear incontinence underwear before changing them?

This comes down to what you’re comfortable with, but our underwear can hold up to 18ml so you should be able to wear one pair all day long.
They are great for periods too. ​​Our absorbent technology supports you through pregnancy and incontinence. Making us period proof, postpartum proof and pee proof with a range of absorbency levels and styles to suit you.

What AWWA styles do you recommend for incontinence?

We recommend the Eva brief, Cotton Brief or Skye High styles

AP have created a health solution company called The Health Collective. The collective consists of a group of trusted experts in the health and wellness field that have personally selected products that will assist our communities health and wellness.
We stock a wide range of select locally produced, ethically sourced, sustainable products to help you keep healthy, recover from injury, support you while you work and play, help you to sleep and relax and to support women during pregnancy, postpartum and beyond.

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