A vaginal pessary is a removable device, made of rubber or silicone. It is worn inside the vagina to support the uterus, vagina, bladder and rectum. It is a minimally invasive, non-surgical treatment option. Its primary use lies in managing conditions related to pelvic-floor prolapse, such as, uterus prolapse, cystocele, rectocele, and stress urinary incontinence. Different types of pessaries are available such as ring, doughnut, and Gellhorn. A doctor can best decide one that will suit your need and condition.
When the muscles and ligaments supporting a woman’s pelvic region weaken, the pelvic organs can drop lower in the pelvis, creating a bulge in the vagina. This is termed as prolapse. There are different types of prolapse, depending on which organ is affected. If it’s the uterus bulging down, it is called uterine prolapse. Prolapse of bladder into the front wall of the vagina is called cystocele. Prolapse of rectum into the back wall is termed as rectocele. The common causes of prolapse are vaginal deliveries, loss of hormones during menopause, obesity and chronic diseases which create considerable abdominal pressure.
Uterus Prolapse
The uterus is held in place by the pelvic muscles and ligaments. Uterine prolapse occurs when the uterus sags or slips from its normal position and into the vagina or birth canal. This is a result of weakened pelvic muscles. Pregnancy, childbirth and a pelvic surgery can weaken the muscles and ligaments. The estrogen hormone, which keeps the pelvic muscles strong, drops with age, weakening the muscles. Obesity, chronic cough, and constipation are the other risk factors.
Wearing a pessary helps push up and stabilize the uterus and cervix.
Cystocele and Rectocele
Cystocele or bladder prolapse occurs when the bladder sags into the vagina. This is a result of the weakening of the muscles between the bladder and vagina.
Likewise, when the rectum bulges into the vagina, it is termed as rectal prolapse or rectocele.
Stress Urinary Incontinence
Involuntary urine leakage during a physical movement or activity such as, running, coughing, sneezing, refers to stress incontinence. When inserted into the vagina, a pessary rests against the back of the pubic bone and supports the bladder. This helps control any accidental urine leakage.
Women using a pessary may witness an increased vaginal discharge which may also develop an odor. Using a vaginal gel and cleaning the pessary often will help in avoiding the odor.
Vaginal irritation may develop. Women who are post-menopausal may need to use an estrogen cream to keep a check on the vaginal irritation.
The pessary may fall out of the vagina. So, ensuring a correct fit is important. There may be times when the pessary may not be successful in correcting the symptoms of pelvic-floor prolapse.
EvaCare Flexible Ring Pessary Without Support is a very common pessary for a first to second-degree prolapse. It is made with flexible silicone which can be folded for insertion. It supports a mild uterine prolapse and a cystocele, but it can also be helpful when used as a diagnostic device during urodynamic testing. The Ring can help to show what effect surgery may have as well as what type of surgery will be most beneficial for the patient. The pessary can act as a surgical facsimile predicting the need for anti-incontinence surgery.
Miltex Pessary Donut are used for the treatment of prolapse. It is used for Uterine Prolapse, Cystocele and Rectocele and is effective for severe prolapse cases, the Donut Pessary treats women afflicted with third-degree prolapse commonly found with older, post-menopausal women. Constructed with flexible silicone, the Donut Pessary is soft and can be compressed for insertion. Donut Pessaries should be removed for sexual intercourse
EvaCare Donut Flexible Pessary is designed for third-degree prolapse as well as cystocele and rectocele. The soft donut can be compressed for insertion. It is used on patients with severe prolapse who are not immediately appropriate for surgery. It works well in a vaginal vault with little or no support, the type commonly found in older, post-menopausal women. Pessary fitting Set available for determining the proper pessary size.
Proper fitting of the pessary often requires the patient to try different sizes and/or styles. The doctor will begin with conducting a complete pelvic examination. After the pessary has been put in place, the fit and effectiveness should be checked. Generally, the largest size pessary a woman can wear is considered to be the most effective.
The follow-up visit is essential wherein the pessary is removed and the vagina is checked for any irritation, pressure sores or allergic reaction. Regular follow-up visits are required. Each time the vagina should be examined and the pessary should be cleaned with soap and water.
Thus, a pessary is a very safe and non-surgical treatment option for conditions connected to pelvic-floor prolapse. It is specifically relevant to those who have limited therapeutic choices, owing to their specific health conditions.
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I am Swati Chadha. Based out of Mumbai, I am currently a stay at home mom. My past work experience has been in the social development sector with focus on reproductive health and HIV/AIDS prevention. Working on different projects ...
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