Active Mom Podcast: Pregnancy, Postpartum, Perimenopause, Menopause & Beyond

Prolapse, Levator Avulsions & Pessaries: What’s Actually Happening (Part 2) — with MELISSA DAVIDSON, PT

Season 5 Episode 217

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0:00 | 46:15

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In Part 2 of this conversation, I’m joined again by Melissa Davidson, specialist pelvic health physiotherapist, clinical educator, and PhD, to go deeper into the clinical realities of pelvic organ prolapse, levator ani avulsions, and pessary use.

This episode moves beyond definitions and into what actually matters in practice: clinical decision-making, patient education, and navigating an evolving pelvic health landscape where access is expanding—but not always with the training to support it.

We talk about how to explain complex diagnoses in a way patients can actually understand, why accurate assessment matters, and how clinicians can balance symptom management with long-term capacity building.

We also unpack the growing conversation around pessaries—including types, fitting considerations, complications, and the rise of over-the-counter options—and what that means for both patients and providers.

This is a nuanced conversation about where pelvic health care is right now… and where it still needs to go.

In this episode, we discuss:

  •  Different types of pessaries and how they’re used 
  •  What levator avulsions are (and why they matter) 
  •  Clinical decision-making in prolapse care 
  •  Potential complications and limitations of pessary use 
  •  The importance of provider training and ongoing education 
  •  What “high tone” actually means (and why it’s often misunderstood) 
  •  The role of mental health and psychological support in pelvic floor conditions


Time Stamps

1:00 avulsions explained

7:05 proper diagnoses of pelvic floor issues

14:00 over-the-counter pessaries

20:55 cutting through the marketing

29:33 expanding access while preserving quality care

33:33 what we don’t know

40:26 how the research changes clinical practice


CONNECT WITH CARRIE

IG: https://www.instagram.com/carriepagliano/

Website: https://carriepagliano.com


CONNECT WITH MELISSA:

Instagram: https://www.instagram.com/drmelissapelvicphysio/

Website: https://www.drmelissadavidson.com/

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