A pessary is usually used to treat a pelvic organ prolapse, a condition that occurs when the tissues or muscles that hold pelvic organs such as the bladder or uterus become weakened and the organs shift from their original position and press against the vaginal wall. Pelvic organ prolapse is commonly associated with labor and childbirth, although it can also be linked to anything that creates increased pressure in the abdomen, including obesity, chronic cough or constipation.
There are several different types of pelvic organ prolapse, including:
- Bladder prolapse (cystocele): In this type of prolapse the wall separating the vagina and bladder stretches or detaches from the pelvic bones, allowing the bladder to fall down into the vagina. Most women with mild bladder prolapse do not have any symptoms, but as the prolapse progresses, it can lead to urinary problems and bladder infection.
- Rectal prolapse (rectocele): In this condition, which usually follows childbirth, the back wall of the vagina weakens, allowing the rectum to bulge in and out of the vagina. Here again, mild prolapses do not usually cause symptoms, but the condition can progress, especially if the woman is constipated.
- Uterine prolapse: In this prolapse, the ligaments and muscles on the pelvic floor that keep the uterus in place become damaged, and the cervix and uterus drops into and eventually out of the vagina. This condition is also sometimes linked to bladder and rectal prolapse—and like this conditions, treatment isn’t usually necessary until the uterus descends far enough to become bothersome.
- Vaginal prolapse after hysterectomy: For some women who have had a hysterectomy, the top of the vagina, where the uterus used to be, detaches from the supporting ligaments, resulting in the tube of the vagina turning inside out. One or more pelvic organs can then prolapse into the protruding bulge.