Vaginal Pessary for Pelvic Support

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.

When to use a vaginal pessary?

Prolapse of uterus

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.

Who can use a vaginal pessary?

• Women with a pelvic-floor prolapse and unfit for undergoing a surgery will definitely benefit from using a pessary.
• Women with a wrongly positioned uterus can also use a pessary.
• It can also serve as a preventive measure in women who have a permanent cough, hay fever, and asthma.
• Sportswomen involved in high impact exercises such as weight training and kickboxing can wear a pessary to avoid strain on the pelvic region.
• Pregnant women for added strength to the pelvic muscles.
• Women with a pelvic floor prolapse looking at having children in the future.

Who cannot use a vaginal pessary?

• Women who have undergone a hysterectomy.
• Women who have undergone a pelvic surgery in the past.
• Women with a short vagina or a wide vaginal opening.
• In case of a severe posterior vaginal wall prolapse.
• Past instances of stress urinary incontinence.
• Women with a vaginal infection or a pelvic inflammatory disease.
• Women with an undiagnosed vaginal bleeding.

Possible risks and problems with pessary use

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.

Types of pessaries

Pessaries are available in different shapes and sizes. The most commonly used pessaries are – ring, cube, donut, dish, shaatz, gellhorn, and ring with a knob.

Selection of a pessary depends on the condition for which a woman is being treated. For instance, in case of a mild uterine prolapse, a ring pessary is inserted. However, if the uterine prolapse is a second or third degree, a cube-shaped pessary will be required.

Choosing and placing a pessary

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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