Pessary

Pessary is a ring-shaped device that is placed inside the vagina or the rectum to provide support to certain organs that have slipped down from their normal position in the body. These devices are useful for the non-surgical treatment of several gynecological problems. Conditions for which pessary rings are used include prolapsed uterus, vaginal vault prolapse, bladder prolapse, retroverted uterus, stress urinary incontinence and management of pelvic support defects such as cystocele and rectocele.
Pessaries are available in different forms. Which pessary is the best and which one to buy will depend on the medical condition being treated.

There are different types of pessaries. Some of the commonly used ones are:

Ring pessary: Ring pessaries are available with support and without support. They are commonly used because they easily fit most women. Ring pessaries are available in four types:
  • Ring
  • Ring with support
  • Incontinence ring
  • Incontinence ring with support
They treat first- and second-degree uterine prolapse. Ring pessary with support is useful foruterine prolapse with cystocele, which is herniation of the bladder. Insertion and removal is easy. Pessary ringsizes are many. Most commonly used sizes in pessary rings are 3 to 5 inches.
Donut pessary: Donut pessary is a space-filling device and is large and thick makingpessary insertion and removal difficult. It is used in the treatment of mild-to-moderate uterine prolapse and in patients with rectoceles and enteroceles.Most commonly used sizes are 2.5 to 3 inches.
Gellhorn pessary: This type is used commonly as a space-filling pessary and comes with a knob which easily folds over for insertion. Once the pessary is in place, the knob rests on the posterior vaginal wall. Gellhorn pessary is used in the treatment of third degree uterine prolapse, severe uterine or vaginal prolapse. Useful for women with more advanced prolapse and less perineal support. Also treats large prolapse of the anterior vaginal wall and patients with a larger cystocele, rectoceles and enteroceles. A Gellhorn pessary is easy to insert, remove and care for.
Gehrung pessary: It is a rarely used pessary because it is difficult to insert and remove. It has an arch design with a malleable rim with wires in the arms. It is used to support cystoceles, rectoceles as well as for second-to-third degree uterine prolapse.
Cube pessary:A cube pessary manages third-degree uterine prolapse. It is useful in patients with a larger cystocele,with rectoceles and enteroceles. It can also be used by women with urinary incontinence before strenuous activities such as tennis, aerobics or jogging.A cube pessary must be removed and cleaned daily because it has no drainage option.
Inflatable: This is a space-filling pessary and must be removed daily for cleaning. It is used in the treatment of mild-to-moderate uterine prolapse and in patients with rectoceles and enteroceles. Made of silicone, these pessaries are inflated after being placed into the vagina. Available in small, medium, large and XL sizes.
Incontinence pessaries: Used particularly for stress urinary incontinence, pessaries for incontinence are available in two types – incontinence dish and incontinence ring. They are not as easy to insert or remove as a ring pessary is. Most commonly used size in incontinence ring is 2 to 7 inches while in incontinence dish it is 3 to 5 inches.

Other types of pessaries are
:
  • Shatz: It is a stiff pessary with a circular base.
  • Lever: Hodge, Smith and Risser are together known as lever pessaries. These are rarely used.

Which pessary is best

No one pessary is the best or worst. Selection of a pessary will depend on your medical condition and which product is most effective for that particular condition. For example, a prolapse support ring can be used to treat first- and second-degree uterine prolapse but for uterine prolapse with cystocele, a ring with support is required. Similarly, for stress urinary incontinence an incontinence ring is needed but for stress incontinence with some degree of cystocele, what will work better is a Gehrung pessary or a Hodge with support.

We carry high grade quality pessaries from Personal Med and Bioteque America designed to offer an effective medical solution for prolapsed bladder and more.
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