Today we are going to discuss common questions regarding pessary use and pelvic floor muscles.
- A question I am often asked by clients and fellow physiotherapists alike is, “Can I do pelvic floor exercises with my pessary in?”. The answer is, “Absolutely!”. In fact, it is likely more beneficial to do your pelvic floor muscle training (PFMT) with your pessary inserted, in the case of pelvic organ prolapse (POP). This is true for many reasons.
First, with your pelvic organs lifted off your pelvic floor muscles, the muscles will not be constantly stretched out by the weight of the organs. Each of the muscles in our body has a favorite “resting length”, a length where they can generate the most force. Think about your biceps muscle for a minute. A biceps curl is hardest at the beginning, when the elbow is relatively straight. It gets easier as the muscle shortens and the preferred resting length is approached, which is where it can generate the most force. The same is true for your pelvic floor muscles. Having the organs lifted off these muscles allows them to settle into their resting length instead of trying to contract from a lengthened position.
Second, depending on the grade of POP, the organs may literally be sitting in the way of the contracting muscles. Think of a box sitting in the way of elevator doors trying to close. The doors can only close part way before they open again. Prolapsed organs present the same dilemma for the pelvic floor muscles: they are unable to “close all the way” or strengthen through their full range of motion if the pelvic organs are in the way. With a pessary inserted, the organs will be lifted out of the way such that the pelvic floor muscles can move through their full range.
Third, having a pessary inserted will help the nervous system remember what it is like to have the organs in their proper place. This effects the muscles and the nerves innervating those muscles. Eventually, pessary use could help the brain re-map where the organs are supposed to be, helping to keep them there.
2. “Is using a pessary going to make my muscles lazy?”.
No, using a pessary is not going to make your pelvic floor muscles lazy. Not using your pelvic floor muscles will though. I am a big advocate for pessary use as an adjunct to pelvic floor muscle training. We cannot insert a pessary and think that it will do all the work. Rather, it is just one factor that can help to better manage your symptoms. If you have weakness, you will still want to strengthen your muscles as best as possible and focus on your breath to ensure you are not breath holding and increasing intra-abdominal pressure when lifting groceries or during other activities of daily living. See our blog on intra-abdominal pressure and the breath in “Exercise and POP” (not only applicable to exercise but also activities of daily life) https://torontopessaryclinic.com/exercise-and-pelvic-organ-prolapse/. So, don’t worry about the pessary making your muscles weaker. Do your PFMT as prescribed and if you don’t know if you are doing pelvic floor muscle contractions properly or have never been assessed, book in to see us today for an evaluation and education on how to use these muscles to serve you and your body best! To learn more about pelvic floor muscle contractions, check out our blog https://torontopessaryclinic.com/the-pelvic-floor-what-is-it/. Note: not all women should be doing pelvic floor muscle contractions (kegels); sometimes doing kegels can make symptoms worse, so be sure to check with a pelvic floor physiotherapist before starting a kegel regimen.
If you have other questions about pessary use and your pelvic floor muscles, leave a comment below!
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.