In was with great excitement in 2021, after completing my studies at the University of South Australia that I purchased a pessary fitting set and supply of vaginal pessaries. I was really excited to increase my scope of practice to be able to support women who did not want to pursue surgery for their pelvic organ prolapse symptoms to have more treatment options provided locally. I have been treating women with symptoms of prolapse for years, helping to strengthen muscular support through pelvic floor muscle exercises and reduce symptoms through lifestyle changes such as good bowel routines and exercise modification, but many of these treatments take time to see results. It has been lovely to be able to fit a pessary and see instantaneous resolution of the uncomfortable heavy feeling within the vagina associated with prolapse.
Mainly I was seeing women who I could teach to self-manage their pessary which mainly involves self removal of the pessary once every 1-2 weeks and resting the vaginal tissues overnight before reinserting the pessary the next morning. But as with most things, once the word got out, I began to get referrals for women with larger prolapses many of whom where older and could not self-manage due to dexterity or personal choice. Pessaries that are inside the body for longer (changed by a health practitioner every 3-6 months) have a greater risk of causing skin breakdowns and the tissue quality of the vagina becomes really important to assess and manage to help prevent erosions. With this in mind, I approached Dr Kim Trueman from Naracoorte GP and am incredibly grateful that she was happy to set up a monthly combined clinic with me to help manage these trickier prolapses and support the assessment and treatment of the vaginal tissues. This clinic has now been running for a year.
It has been a pleasure working with Dr Trueman.
Working collaboratively not only improves outcomes and services for patients but during every clinic I learn something new. With Dr Trueman’s postnatal workload, we have also been able to manage symptoms of prolapse in the early postnatal period and allow these women to get back to simple activities such as cooking dinner and going for a walk without experiencing heaviness and dragging, and the worry they are doing their tissues more harm.
I have also been fitting pessary's on women who are not symptomatic of prolapse at any other time except when exercising or playing sport. Often these women will wear the pessary just for these activities. It has been a joy to help women return to exercise, symptom free, when in the past they may have excluded themselves, as well as hopefully preventing a progression of their prolapse by providing more support to the vaginal tissues and uterus while participating in high impact activities.
With prevention in mind, recent research shows that women with an injury to the attachment of the pelvic floor (usually sustained through birth trauma) are more likely to have prolapse symptoms later in life than women who do not have this injury. Now, in our recommended 6-week postnatal check, if this birth injury is detected, I will discuss a pessary as an option to use while exercising. This will help to improve the support to the tissues, particularly during the period of recovery, healing and rehabilitation which is happening after birth.
Completing my studies was certainly challenging with three children and juggling work with family life but I have really enjoyed being able to extend the services I can offer and providing the opportunity for Limestone Coast women to have their pessaries fitted and managed locally.