A pessary is a soft, medical-grade silicone device placed inside the vagina. It is a non-surgical option providing mechanical support to the pelvic organs. Pessaries commonly manage symptoms of pelvic organ prolapse or stress urinary incontinence by holding organs in their correct anatomical position. Because of its internal placement, questions arise regarding its influence on neighboring organs. This discussion explores how the pessary’s physical presence can relate to bowel function.
What a Pessary Does
The primary function of a pessary is to mechanically support weakened pelvic floor structures. Pelvic organ prolapse (POP) occurs when organs like the bladder, uterus, or rectum descend into the vaginal canal due to compromised supportive tissues. The pessary is sized and shaped to sit in the vaginal vault, creating a supportive shelf to prevent this descent.
Common types include the ring pessary for mild to moderate prolapse, and space-filling shapes like the cube or Gellhorn for more advanced cases. The specific design lifts and stabilizes the organs, relieving uncomfortable sensations of pressure or bulging. This support also helps restore the proper function of the urethra, which can alleviate symptoms of stress urinary incontinence.
Physical Relationship Between the Pessary and the Rectum
The physical proximity of the vagina and the rectum explains why a pessary can affect bowel movements. The two structures are separated only by the rectovaginal septum. When a pessary is inserted, especially a larger device used for significant prolapse, it occupies this shared space.
The device may exert external pressure directly onto the front wall of the rectum, which is located immediately behind the vagina. This mechanical compression can impede the smooth passage of stool. A common resulting symptom is difficulty with defecation or the sensation that the rectum has not been completely emptied, a feeling known as tenesmus.
This mechanical interference can contribute to constipation or worsen pre-existing constipation by making it harder for the bowel contents to pass the point of compression. The effect is purely physical, arising from the device’s size and placement. A pessary that is too large or incorrectly fitted is more likely to cause this pressure-related difficulty.
Addressing Changes in Bowel Function
If a pessary is causing changes in bowel function, initial management often focuses on optimizing stool consistency to minimize straining. Increasing the intake of dietary fiber through foods like fruits, vegetables, and whole grains adds bulk and softens the stool. Adequate hydration, generally aiming for 1.5 to 2 liters of water daily, is also important, as sufficient fluid keeps the stool soft and reduces the likelihood of hard, difficult-to-pass masses.
Some people find it helpful to use a footstool while having a bowel movement, as elevating the knees above the hips can naturally straighten the anorectal angle. Over-the-counter osmotic agents, commonly referred to as stool softeners, may be used temporarily to draw water into the colon, further easing passage. These self-management techniques are often sufficient to mitigate minor pressure effects from the pessary.
If bowel changes persist, or if they are accompanied by significant pain, inability to pass stool, or rectal bleeding, contact a healthcare provider promptly. These signs can indicate that the pessary’s fit is causing excessive pressure or potentially irritating the vaginal wall. The solution typically involves a professional re-evaluation of the device, which may lead to an adjustment in its position, a change to a different shape, or fitting a smaller size to alleviate the mechanical compression on the rectum.