What is a Vaginal Pessary?
A vaginal pessary is a medical device designed to be inserted into the vagina to support the pelvic organs, particularly in cases of pelvic organ prolapse (POP) or urinary incontinence. It helps alleviate symptoms and provides structural support to the pelvic area when the muscles and ligaments that normally support the pelvic organs (such as the bladder, uterus, and rectum) become weakened.
Types of Vaginal Pessaries:
There are various types of pessaries, and the choice of pessary depends on the type and severity of the prolapse, as well as personal comfort. Some common types include:
Ring Pessary:
This is the most commonly used type of pessary. It’s a simple, flexible ring that is inserted into the vagina to support the bladder and prevent further prolapse.
Some ring pessaries also have a knob or support at the front to help support the bladder more effectively, especially in cases of cystocele (bladder prolapse).
Gellhorn Pessary:
This is a more rigid, disk-shaped pessary with a stem that extends into the vagina. It's used for more severe prolapse and is often recommended for uterine or vaginal vault prolapse.
The disk is designed to support the entire pelvic floor.
Cube Pessary:
This type is shaped like a small cube and is used in cases of uterine prolapse. It’s inserted into the vagina and provides support by gently lifting the uterus.
Shelf Pessary:
This is a rigid, shelf-like device that provides support for the bladder and rectum, typically used in cases of rectocele (rectal prolapse) or cystocele.
Donut Pessary:
Similar to the ring pessary but with a thicker, more flexible design, the donut pessary is often used in mild cases of prolapse, especially for cystocele.
How It Works:
Supports the pelvic organs: The pessary acts as a physical support for the pelvic organs (bladder, uterus, rectum), preventing them from sagging further into the vaginal canal. This support can reduce the symptoms of prolapse, such as bulging, discomfort, and urinary or bowel issues.
Alleviates symptoms: In addition to providing support, a pessary helps alleviate discomfort or pressure caused by prolapse. It may also help with urinary incontinence and improve bladder control.
Provides a non-surgical option: Pessaries can be a good alternative to surgery for women who are not ready for or are not candidates for surgical treatment. They can also be used temporarily (for example, during pregnancy) or long-term if other treatments are not effective.
Insertion and Use:
Professional fitting: A healthcare provider, typically a gynecologist or pelvic health specialist, will help you select the appropriate pessary and show you how to insert and remove it. It's important that the pessary is properly fitted to avoid discomfort, vaginal irritation, or leakage.
Self-care: Once you are properly fitted, you may be able to manage the pessary on your own. It’s important to clean the device regularly and to follow your healthcare provider's instructions about how often it should be removed and replaced.
Benefits of Using a Vaginal Pessary:
Improved quality of life: By reducing symptoms like pelvic pressure, incontinence, and prolapse bulging, a pessary can significantly improve daily comfort and functioning.
Non-invasive: For women who are not candidates for surgery or prefer a non-surgical option, a pessary offers an alternative solution to support pelvic health.
Reversible and adjustable: Unlike surgery, the use of a pessary can be adjusted or discontinued at any time, giving women more control over their treatment options.
Potential Side Effects and Considerations:
Vaginal irritation: Some women may experience irritation, discomfort, or vaginal discharge when using a pessary, particularly if it's not properly fitted or if it's left in for too long without removal.
Difficulty with removal: Some women may find it difficult to remove the pessary, especially if it's larger or not positioned correctly. This is why a healthcare provider's guidance is crucial, particularly in the beginning.
Increased risk of infection: If a pessary is not cleaned regularly or if it is left in for too long, there is a risk of developing vaginal infections, such as bacterial vaginosis or yeast infections.
Possible prolapse progression: While a pessary can provide temporary relief, it doesn't address the underlying causes of prolapse, such as weakened pelvic floor muscles. In some cases, surgery or pelvic floor physical therapy may be needed for long-term management.
How to Care for a Vaginal Pessary:
Clean it regularly: A pessary should be removed, cleaned, and reinserted regularly (typically every 1–3 months, depending on the type and your healthcare provider's advice).
Check for signs of irritation: Pay attention to any signs of vaginal irritation or discomfort, such as unusual discharge, redness, or soreness. If these occur, consult your healthcare provider.
Monitor for changes: If you experience any changes in symptoms or difficulty with the pessary, such as increased bulging or leakage, let your provider know so the pessary may be adjusted.
Who Can Benefit from a Vaginal Pessary?
Women with pelvic organ prolapse: Especially those with mild to moderate prolapse who want a non-surgical option to manage their symptoms.
Women with urinary incontinence: Pessaries can help support the bladder and reduce leakage.
Women who are not candidates for surgery: Pessaries are a great option for those who cannot or do not want to undergo surgery.
When to Consult a Healthcare Provider:
If you're considering a pessary for prolapse or incontinence, it’s essential to consult a pelvic health specialist or gynecologist for a proper diagnosis, fitting, and follow-up care. They will assess the severity of your condition and help you choose the right pessary for your needs.
In summary, a vaginal pessary is a valuable tool for managing pelvic organ prolapse and urinary incontinence. It provides support, alleviates symptoms, and can serve as a non-invasive treatment option, but it requires proper fitting, care, and ongoing medical supervision.