Pessary or Surgery for Pelvic Organ Prolapse: Which Treatment Is Right for You?

Understanding Two Very Different Approaches to Treating Pelvic Organ Prolapse

After being diagnosed with pelvic organ prolapse, many women are presented with two very different treatment options:

• A pessary
• Pelvic reconstructive surgery

Naturally, one of the first questions they ask is:

“Which treatment is better?”

The answer depends on far more than the stage of your prolapse.

Choosing between a pessary and surgery requires careful consideration of:

• Your symptoms
• The type of prolapse you have
• Your age and overall health
• Your activity level
• Future pregnancy plans
• Previous pelvic surgery
• Your personal goals and lifestyle

For some women, a pessary provides excellent symptom relief for many years.

For others, surgery offers a more durable long-term solution.

At Miklos & Moore, Dr. John Miklos and Dr. Robert Moore believe that every woman deserves to understand all of her treatment options before making a decision. As fellowship-trained urogynecologists specializing in Female Pelvic Medicine and Reconstructive Surgery (FPMRS), they perform a comprehensive pelvic floor evaluation and develop individualized treatment recommendations based on each woman’s anatomy, symptoms, and goals—not a one-size-fits-all philosophy.

What Is a Pessary?

A pessary is a removable silicone medical device that is placed inside the vagina to support the pelvic organs.

Rather than repairing prolapse, it provides mechanical support that helps reduce symptoms while the pessary is in place.

Pessaries come in many different shapes and sizes.

Your physician selects the type that best fits your anatomy and the specific type of prolapse being treated.

Many women are surprised by how comfortable a properly fitted pessary can be.

Benefits of a Pessary

For many women, a pessary offers several advantages:

• No surgery
• No anesthesia
• Can often be fitted during an office visit
• Immediate support for pelvic organs
• Short recovery because no operation is performed
• Can often be removed if treatment goals change

A pessary may be an excellent option for women who wish to delay surgery, have medical conditions that increase surgical risk, or simply prefer a conservative approach.

What Are the Limitations of a Pessary?

Although pessaries are highly effective for many women, they are not a permanent cure for pelvic organ prolapse.

Some women may experience:

• The need for periodic cleaning and follow-up visits
• Difficulty finding the right fit
• Vaginal irritation or discharge in some cases
• Continued symptoms despite pessary use
• The need to remove and reinsert the device, depending on the type of pessary and individual circumstances

For some women, these factors are minor.

For others, they become the reason they eventually consider surgery.

What Does Surgery Accomplish?

Unlike a pessary, surgery is designed to repair the weakened support structures responsible for pelvic organ prolapse.

Depending on the type of prolapse, surgery may involve:

• Native tissue repair
• Robotic pelvic reconstructive surgery
• Vaginal prolapse repair
• Vaginal vault suspension
• Uterine-preserving prolapse surgery when appropriate
• Combination procedures if multiple compartments are involved

The objective is to restore pelvic support while improving bladder, bowel, and sexual function whenever possible.

Benefits of Surgery

For appropriately selected patients, surgery may provide:

• Long-term anatomical correction
• Relief of pelvic pressure
• Reduction of the vaginal bulge
• Improved bladder and bowel function in many women
• Elimination of the need for a pessary

Because every woman is different, the expected benefits depend on the specific procedure being performed and the underlying pelvic floor condition.

Which Treatment Is Right for You?

There is no universal answer.

A woman with mild prolapse who is comfortable using a pessary may successfully avoid surgery for years.

Another woman with advanced prolapse that significantly affects her quality of life may decide that reconstructive surgery offers the best opportunity for lasting improvement.

The decision should never be based solely on the stage of prolapse.

Instead, it should consider:

• Your symptoms
• Your anatomy
• Your daily activities
• Your medical history
• Your expectations
• Your personal preferences

The best treatment is the one that aligns with your goals after a comprehensive evaluation by a specialist experienced in treating the full spectrum of pelvic organ prolapse.

Who Is a Good Candidate for a Pessary?

A pessary is an excellent treatment option for many women, but it is not the right choice for everyone.

Women who often do well with a pessary include those who:

• Have mild to moderate pelvic organ prolapse
• Want to avoid or postpone surgery
• Plan to become pregnant in the future
• Have medical conditions that increase surgical risk
• Are not significantly bothered by pessary maintenance
• Prefer a non-surgical approach

Many women successfully wear a pessary for years while maintaining an active lifestyle.

The key is selecting the correct pessary and ensuring it fits comfortably.

Regular follow-up visits are important to monitor vaginal health and confirm that the pessary continues to provide adequate support.

Who Is a Good Candidate for Surgery?

Surgery may be the better option when pelvic organ prolapse significantly affects your quality of life or when conservative treatment no longer provides adequate relief.

Women often consider surgery if they:

• Feel a bulge protruding beyond the vaginal opening
• Experience persistent pelvic pressure or heaviness
• Have difficulty emptying the bladder
• Have bowel symptoms related to prolapse
• Have difficulty exercising or remaining active
• Are no longer satisfied with pessary management
• Want a more durable treatment option

Every surgical recommendation should be individualized based on your anatomy, symptoms, and personal goals.

Can You Try a Pessary Before Choosing Surgery?

Absolutely.

Many women choose to try a pessary first.

Using a pessary does not prevent you from having surgery later if your symptoms change or if you decide that surgery is the better long-term solution.

Likewise, some women discover that a properly fitted pessary controls their symptoms so well that they postpone—or even avoid—surgery.

There is no “right” order.

The best approach is the one that fits your needs and lifestyle.

Can a Pessary Prevent Surgery?

Sometimes.

For women with mild or moderate symptoms, a pessary may provide excellent symptom relief for many years.

However, it is important to understand that a pessary does not repair weakened muscles or stretched connective tissues.

Instead, it provides support while it is being worn.

If prolapse progresses or symptoms become more bothersome despite pessary use, surgery may eventually become the preferred option.

Why Women Choose Dr. John Miklos & Dr. Robert Moore

One of the greatest strengths of Miklos & Moore is their commitment to helping women choose the treatment that is truly best for them—not simply the treatment that is easiest to perform.

Dr. John Miklos and Dr. Robert Moore are fellowship-trained urogynecologists specializing in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). They have devoted their careers to diagnosing and treating pelvic organ prolapse, urinary incontinence, childbirth-related pelvic floor injuries, vaginal laxity, and other complex pelvic floor disorders.

Rather than recommending surgery for every patient—or encouraging every woman to continue with conservative care—they take the time to understand each patient’s unique situation.

Their comprehensive evaluation includes:

• The type and severity of prolapse
• Bladder function
• Bowel function
• Pelvic floor muscle strength
• Vaginal support
• Previous pelvic surgery
• Medical history
• Lifestyle and activity level
• Long-term treatment goals

This individualized approach allows them to recommend the treatment most likely to improve comfort, restore function, and enhance quality of life.

When surgery is appropriate, they offer advanced reconstructive options, including robotic and vaginal prolapse repair. When non-surgical treatment is the better choice, they help women successfully manage prolapse with pessary therapy and other conservative approaches.

Women travel from Atlanta, throughout Georgia, across the United States, and internationally because of their extensive experience, fellowship training, and reputation for providing honest recommendations based on each woman’s needs rather than a one-size-fits-all treatment philosophy.

Questions to Ask During Your Consultation

Whether you are considering a pessary or surgery, asking the right questions can help you make a confident, informed decision.

Consider discussing:

• What type of prolapse do I have?
• How severe is my prolapse?
• Am I a good candidate for a pessary?
• What are the advantages and disadvantages of surgery in my case?
• Which surgical approach would you recommend and why?
• How long is the expected recovery?
• How might treatment affect my bladder, bowel, and sexual function?
• What can I expect over the next 5 to 10 years?

An open conversation with your surgeon helps ensure that your treatment plan aligns with your goals, lifestyle, and expectations.

The Bottom Line

There is no single “best” treatment for pelvic organ prolapse.

For some women, a pessary provides excellent long-term symptom control without surgery.

For others, reconstructive surgery offers the most durable solution and the greatest improvement in quality of life.

The most important step is obtaining an accurate diagnosis from a fellowship-trained urogynecologist who can explain every available option and help you understand the benefits and limitations of each.

At Miklos & Moore, treatment decisions are based on your anatomy, your symptoms, and your goals—not on a predetermined treatment plan. By taking the time to understand the complete picture, Dr. John Miklos and Dr. Robert Moore help women choose the option that is right for them and move forward with confidence.