Pessary For Pelvic Organ Prolapse
Starting around that period, some parts of our organs can no longer defy gravity to a point where it may need external support while other get weak, degenerate, break or fail. For those with heart ailments, they may require pacemakers. Those with busted knees may require knee implant surgery, while those who broke their hips may have to have hip replacement surgery. You get the picture.
In like manner, the vagina may not keep its structure over time, as well. For some poor unfortunate souls, bowels and other tubular structures around the vagina may droop into the vaginal walls, requiring the use of tools like the vaginal pessary.
Before we discuss what a vaginal pessary is, we need to understand the reason why an individualmight need it. The chief condition that necessitates the use of a vaginal pessary is called the “pelvic organ prolapse.” We discuss what it is in the next section.
Before we define “pelvic organ prolapse” in itself, let’s define what “prolapse” means.
So when one of the structures within the pelvic area falls out of place and impinge on the vagina and vice versa, you have a “pelvic organ prolapse.”
These conditions listed, you may now have an idea of what a pelvic organ prolapse is, and the types of pelvic organ prolapses there are.
In more recent years, a condition called stress urinary incontinence (SUI), which happens when a person cannot control passing small amounts of urine while sneezing, coughing, or exercising, is another common problem among women. SUI can warrant the use of a vaginal pessary.
A vaginal pessary is a flexible, firm device placed inside your vagina to hold up or mechanically push up your prolapsing tissue. This may be prescribed to manage conditions you may have, including POP, SUI, or both. It can also serve to support and reposition your urethra or uterus.
For your information, the vaginal pessary has been around for centuries. It has provided women a conservative (non-surgical) alternative for managing the symptoms of both POP and SUI.
Generally, the vaginal pessary is inert and made of plastic or silicone material. Nowadays, this device may be recommended by a healthcare provider for the following reasons:
For a clearer picture of what a vaginal pessary is, we can take a look at the different definitions of what it is around the web:
You need to consult a medical provider regarding your condition before using this device because some women are not good candidates for using the vaginal pessary. These may include women who have severe forms of POP, or if your vaginal opening is too large. In this case, the vaginal pessary will simply be pushed out, or fall out, once you stand up.
Sizes & Shapes
If you’re planning to use a vaginal pessary, you should know that this device comes in all sizes and shapes. Hence, you may need to have your condition assessed by your health provider to choose the best pessary for you. And be sure to get one that fits your size.
According to a study in the International Urogynecology Journal & Pelvic Floor Dysfunction, most women with SUIs can be successfully fitted by a trained nurse practitioner, registered nurse, or physical therapist after one or two fittings.
Sizes typically range from 0 (1.75 in/44 mm diameter) to 10 (4.25 in/108 mm diameter). In the study, among women with SUIs in the US, approximately 2/3 could be fitted with a size 2-4. It was found that the average diameter was 69 mm, which is approximately a size 3.
Before fitting, your healthcare provider will assess the conditions of your POP and do some measurements of the internal dimensions of your vagina to fit you with the best style and size of device for your needs.
Credits: LabIVF Vaginal Ring Pessaries
Does it hurt?
A good fit should not be felt within your vagina, and should not be too tight against your vaginal walls. This can be checked by running a fingertip between the outer edge of the device and your vaginal walls. Additionally, you should have no discomfort when going to the bathroom, and it should not fall out even when you bear down.
During fitting with your healthcare provider, the vaginal pessary should not cause you vaginal or low abdominal discomfort/pain in a lying down or upright position. Although, some women report experiencing minimal pelvic discomfort during fitting.
If you feel any discomfort/pain after the process of fitting, you need to inform your health provider, so assessment of your symptoms can be done accordingly.
Types of Vaginal Pessaries
More types of pessaries can be used. Dr. Peter M. Lotze, MD, lists the ring, inflatable, doughnut, and Gellhorn, while the American Family Physician has a table of the pessaries that a patient can consider using.
Health Products For You also has a great page about the types of pessaries available, and what they can be used for.
Insertion & Removal of the Device
Using the vaginal pessary may be done in the comfort of your home. But for first-timers, you may need to ask for instructions from a healthcare provider. The following are general steps that are advised:
Note that bearing down (as if you are having a bowel movement) can help push forward the rim of the device, so you can take it out more easily. Moreover, if you are interested to learn how to remove or reinsert the device by yourself, seek help from your health provider for proper home instructions and supervision.
Although there are types of pessaries that you can insert on your own, it is really best to consult the doctor first so that you can also be monitored for adverse reactions to the pessary.
Generally, the vaginal pessary as management for POP and SUI is considered well-tolerated, safe, and cost-effective. Although some claim that the overall effectiveness is not yet established due to limited data.
In a 2019 study in the Journal Medicine (Baltimore), the long-term use of the vaginal pessary is considered safe and cost-efficient. The device use seems to be more acceptable to olderindividuals, as it significantly impacts their quality of life. Additionally, it was found that severe stress urinary incontinence was noted among more aged women who were treated with the vaginal pessary for POP, but with poor long-term compliance.
Take note that all vaginal pessaries have some risk of infection or irritation. Let your healthcare provider know if you notice adverse complications including:
Tips, Care, and Cleaning
Hygiene is very important in the use of pessaries. Misused, pessaries can do more harm than good, such as in the case of this 80-year-old widow in India, who had a vaginal pessary inserted to treat her prolapse after childbirth. She apparently forgot that the pessary was inserted inside her, so she ended up seeking treatment for a foul feminine odor and a discharge, which ended up in the discovery of the forgotten pessary. Thus, here are the tips in how to take care of a vaginal pessary, if you have one:
Where to Buy a Vaginal Pessary
Recently, a disposable, single-use vaginal pessary was approved for use in the US. It can be purchased over-the-counter even without a prescription. Typically, the disposable kind can stay in for a maximum of eight hours. The disposable type is inserted with an applicator (like a tampon), and can be removed by pulling a string.
You can buy the device from your local store or hospital, or even on-line. If you want to be sure of the brand to use, seek advice from your healthcare provider in acquiring the device. On average, the price with delivery may range from $50 to $100.
Healthline details the process of obtaining a pessary, as well as when/why you should go back to your doctor (even before your scheduled follow-up appointment).
Options for Managing Pelvic Organ Prolapse
When you feel the symptoms of pelvic organ prolapse: feeling the pressure, pain, or a sensation of fullness in the pelvic area, feeling like something is falling out of your vagina, backache, among others, don’t take matters into your own hands and do a DIY. Always speak with your doctor or OB-GYN and discuss your options.