Living with a heaviness, dragging feeling or a bulge down below can be uncomfortable, worrying and hard to talk about. If you have been diagnosed with pelvic organ prolapse, it is completely understandable to feel unsure about what happens next.
For many women, a pessary offers a non-surgical way to help manage prolapse, while surgery is generally considered for more advanced cases or when other approaches have not brought enough relief.
Choosing between a pessary and surgery can feel overwhelming. At DX Physio, we’re here to help you understand the pros and considerations of each option so you may make the decision that’s right for your body and lifestyle.
What is Pelvic Organ Prolapse?
Pessary vs. Surgery: What is the Difference?
What is a Pessary and How Does Pessary Fitting Work?
When is Surgery Considered for Prolapse?
How to Choose Between a Pessary and Surgery
How DX Physio Supports Prolapse Management in Sydney
Common Pessary and Prolapse Care Questions
Get Personalised Prolapse Support at DX Physio
Key Takeaways
- Pelvic organ prolapse is when organs like the bladder, uterus or bowel press against the vaginal walls, and it affects up to half of women over their lives.
- A pessary is a removable, non-surgical device that supports the pelvic organs, while surgery is a permanent repair of the supporting tissues.
- Pessaries are often tried first for milder prolapse, with surgery generally considered for more severe cases or when other options have not helped enough.
- Pessary fitting involves finding the right size and shape for comfort, plus regular follow-up.
- The right choice depends on your symptoms, lifestyle, future plans and personal preferences.
- DX Physio’s women’s health physio team in Sydney can assess your prolapse and talk through your options.
What is Pelvic Organ Prolapse?
Pelvic organ prolapse happens when one or more of the pelvic organs, such as the bladder, uterus or bowel, drop from their usual position and press against the vaginal walls.
It may cause a feeling of heaviness, a visible or palpable bulge, and discomfort during daily activities. It is common, particularly after childbirth or around menopause.
According to the Australian and New Zealand Continence Journal, pelvic organ prolapse affects up to 50 per cent of women during their lives. If this is you, please know you are far from alone, and that support is available.
Pessary vs. Surgery: What is the Difference?
A pessary is a removable device that supports the pelvic organs from inside the vagina, while surgery repairs the supporting tissues through an operation.
A pessary is non-surgical and reversible. Surgery is more involved and is generally reserved for more significant prolapse or when other options have not helped enough.
Here is a simple comparison:
| Feature | Pessary | Surgery |
|---|---|---|
| What it is | A removable support device worn in the vagina | An operation to repair pelvic support tissues |
| Invasiveness | Non-surgical | Surgical, usually under anaesthetic |
| Reversible | Yes, it may be removed at any time | No, it is a permanent repair |
| Recovery | Little to no downtime | Recovery period of several weeks |
| Often suited to | Mild to moderate prolapse, or delaying or avoiding surgery | More severe prolapse, or when symptoms persist |
| Who provides it | May be fitted by a women's health physio or GP | Performed by a gynaecologist or urogynaecologist |
What is a Pessary and How Does Pessary Fitting Work?
A pessary is a soft, flexible device, often a ring, placed in the vagina to hold the pelvic organs in a more comfortable position. Pessary fitting is the process of finding the shape and size that suits your body. It is non-surgical and may often be done within a clinic appointment.
Pessary fitting usually involves:
- An assessment of your symptoms and the type and stage of prolapse
- Trying different sizes and shapes to find a comfortable fit
- Checking that you can move, empty your bladder and go about your day comfortably
Learning how to care for the pessary, and in some cases how to remove and reinsert it yourself - Regular follow-up, which Jean Hailes notes is generally recommended every four to six months
When is Surgery Considered for Prolapse?
Surgery aims to repair and strengthen the tissues that support the pelvic organs. It is generally considered for more severe prolapse, or when symptoms have not improved with physiotherapy or a pessary.
Recovery takes time, and like any operation, it carries some risks worth discussing with your GP.
Surgery is usually required to repair a severe prolapse, or when symptoms do not improve with physiotherapy. For milder prolapse, regular pelvic floor physiotherapy may help in many cases, and a pessary may be tried first.
‘When women hear the word prolapse, they often assume an operation is inevitable. It usually isn’t. There’s a lot we can do together before surgery ever enters the picture’.
– Wendi Jin, Women’s Health Physio
How to Choose Between a Pessary and Surgery
The right choice depends on your body, your symptoms and what matters to you. There is no single correct answer, and many women understandably prefer to try conservative options before considering surgery.
Factors that may influence your decision include:
- The type and severity of your prolapse
- How much your symptoms affect daily life, work and exercise
- Whether you are planning to have more children
- How you feel about surgery, anaesthetic and recovery time
- Any other health conditions you have
- Your own preferences and comfort with each option
Pairing any option with pelvic floor exercises for prolapse may help support your pelvic floor over time.
How DX Physio Supports Prolapse Management in Sydney
You do not have to work this out on your own. DX Physio is a womens health physio in Sydney, with clinics in Cremorne and Balgowlah, supporting women through pelvic floor assessment and conservative prolapse management. Our team takes the time to listen, explain your options clearly, and tailor a plan to your goals.
Common Pessary and Prolapse Care Questions
How successful are pessaries for prolapse?
Pessaries are a widely used, non-surgical option, and many women find they relieve symptoms like heaviness and bulging while worn. Success varies between individuals, as fit, comfort and prolapse type all play a part, so a proper assessment helps find what may suit you.
What happens if you don't treat a prolapse?
A mild prolapse may stay stable and not need active treatment, but for some women symptoms may gradually become more noticeable over time. If it is affecting your comfort or daily life, it is worth having it assessed so you understand your options.
At what point does a prolapse require surgery?
Surgery is generally considered for more severe prolapse, or when symptoms have not improved with pelvic floor physiotherapy or a pessary. There is no single cut-off, so the decision is guided by your symptoms, examination and personal preferences.
What is the average age for prolapse surgery?
Prolapse surgery is most often performed in women between 65 and 74, as prolapse tends to become more common with age and after menopause. That said, it may be done earlier or later depending on individual circumstances.
Why avoid prolapse surgery?
Some women prefer to delay or avoid surgery because it is more involved, needs recovery time, carries the usual risks of an operation, and prolapse may sometimes return afterwards. Trying conservative options like physiotherapy or a pessary first may be a gentler place to start.
Get Personalised Prolapse Support at DX Physio
Deciding between a pessary and surgery can feel daunting, especially when prolapse is already affecting how you feel day to day. The reassuring news is that you have options, and for many women a pessary offers a gentle, non-surgical place to start.
If you would like clear, compassionate guidance, the women’s health physio team at DX Physio can assess your prolapse, talk through pessary and surgical pathways, and support your pelvic floor.
