Pessary for Prolapse
A pessary is a silicon device used to hold up the bladder, uterus, rectum or vagina, to treat prolapse, pressure and sometimes urinary incontinence. There are many different shapes and sizes of pessaries, but the most common shapes is round. The variations allow for a proper fit and function depending an individual woman’s needs.
Fitting and Use
Here is how pessary is used in gynecologic care of prolapse, vaginal pressure and urinary problems.
- A patient is evaluated for certain symptoms related to prolapse or urinary problems. Examples include leaking urine with coughing or sneezing, difficulty emptying the bladder fully, a fallen uterus or bladder, and trouble using tampons because they fall out.
- We find on examination that there is prolapse. Organs which prolapse in the vagina include the rectum, bladder, urethra, uterus and top of the vagina after hysterectomy.
- We confirm or suspect a connection between symptoms and the prolapse.
- A patient chooses to have treatment for the symptoms.
How It’s Done
Symptoms from prolapse can be treated by putting the pelvic organs Back where they belong. This can be done with surgery or a pessary. The pessary is often a simple, safe solution that does not involve surgical risk or recovery.
First we need to find the right pessary, shape and size. Pessary fitting is done at an office visit, and can take 5-20 minutes. It’s a trial and error process, until we find the right one.
- First, we find a pessary that is not too big. A woman should NOT be able to feel the pessary when in place. Its not enough to say “I don’t mind the pressure,” or “I don’t think I feel it.” The patient should NOT be able to feel the pessary when in place.
- Next, we need to be sure it does not fall out. The patient will try to make the pessary fall out by coughing, sneezing, squatting and jumping. This is done in the exam room, alone, after the health care providers step out.
- If the pessary falls out, we need to find a bigger one OR a different shape/type.
- Once we establish the pessary fits, is not felt by the patient, and does not fall out immediately, the patient will get back dressed with the pessary in place, in the vagina.
Next, we need to see if the pessary helps the symptoms. The easiest thing to do is go home with the pessary, and leave it in for 5 to 15 days. Then we have a follow up visit. At the follow up visit we discuss if the pessary is helping, or not. If the pessary is not helping, we either fit another one, move toward surgery, or leave the symptoms untreated for now. If the pessary is helping then we figure out a regimen of removing and cleaning the pessary. The schedule for cleaning depends upon the pessary and the patient.
- Some patients are able to remove, clean, and replace their own pessary. Clean the pessary with soap and water. Store it in the sock drawer, not in direct sunlight and not wrapped in plastic. Daily removal can be irritating.
- Some patient are not able to remove and replace the pessary on their own. These patients come to the office every 2-4 months, depending on the amount of discharge or odor they experience.
Most women will have an increase in discharge with the pessary in place. The discharge can smell bad. Sometimes, the pessary can cause incontinence of urine. Rarely, the pessary can cause pain or bleeding. In really rare cases it can be difficult to urinate or have a bowel movement with the pessary in place. The pessary should be removed for any of these problems, and a follow up appointment arranged. If a patient can not remove the pessary at home, she should make an appointment to have the pessary removed.
When removing or replacing the pessary at home, use lubrication. Folding pessaries go UP, like a U or V, as they go in. All pessaries should be placed all the way in. You can not get it too far in. The knob should point OUT, if present. It may be necessary to rotate knob pessaries to place and remove.