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What is a 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. At HPFY, we offer a wide range of pessaries from top manufacturers like Medline, Personal Med, Bioteque, etc.

Benefits and side effects of using a Pessary?

Most women find they can successfully use a pessary for two years or more without requiring surgery for their condition.
Pessary use often causes mild side effects, such as vaginal pain, foul-smelling discharge, and urinary tract infections. Since the pessary is removable, however, any side effects encountered can be quickly reversed.

How to insert a Pessary Device?

  • A pessary will be inserted by a medical professional, usually a gynecologist, in an initial fitting. To find the right one, they may need to try various types and sizes.
  • They will offer training on inserting and cleaning the pessary by yourself once the fitting is right.
  • Return to the clinic a week later to check the device’s fit.  The gynecologist will remove the pessary so they can check the vagina for signs of irritation. They will then clean and replace it so long as all is well.
  • Usually, there will be further follow-up appointments for two weeks and six months later, but some women may need to return more frequently. You will also be offered an annual examination for the vaginal wall.

What are the different types of Pessaries?

Pessaries are available in different forms. The right one to select depends on the medical condition being treated.

Ring Pessary

Ring pessaries are available with support and without support. They are commonly used because they easily fit most women. Pessary ring comes in many sizes, most commonly used sizes in pessary rings are 3 to 5 inches. Ring pessaries are available in four types:
  • Ring pessary useful for uterine prolapse with cystocele, which is herniation of the bladder
  • Ring with support that makes insertion and removal is easy
  • Incontinence ring
  • Incontinence pessary ring with support

Donut Pessary

Donut pessary is a space-filling device and is large and thick making pessary 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 with knob is easy to insert, remove and care for.

Gehrung Pessary

Gehrung pessary 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 Pessary

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 ring pessary for bladder incontinence is 2 to 7 inches while in incontinence dish it is 3 to 5 inches.

How to choose the right Pessary?

No 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.
  • 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 top brands designed to offer an effective medical solution for prolapsed bladder and more.

How to Care for the Vaginal Pessary?

  • You may remove the pessary once or twice a week if you are comfortable removing and reinserting your own pessary. Clean it with mild soap and warm water after it has been removed, and then rinse before replacing it. Your doctor may prescribe a vaginal estrogen cream to apply inside your vagina while the pessary is out to avoid discomfort.
  • Pessaries can fall out if you strain. Try not to bear down during the bowel movements, if you can. You should reinsert it after you clean it if the pessary does fall out.
  • Many women find insertion easier when they are standing up with one foot resting on a stool. It’s important to use plenty of water-based lubricant for insertion.
  • Your doctor will set up follow-up appointments for you to come and do it in the office if you are not comfortable extracting and reinserting your own pessarium. Depending on your needs, the frequency of visits will vary from every month to every three months.

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