HWN Suggests

Pessaries. The Facts

It is NOT TRUE that pessaries are only for ‘oldies’. Any woman can have a pessary. Some older women choose a pessary because they might not be suitable for an operation, and they want to feel better rather than ‘be cured’. But recently so much has changed. Operations for prolapse are being done much less often, older women are much fitter than they used to be, and the truth is that no treatment for prolapse is perfect. Operations may need to be redone, or don’t work fully; a suitable pessary may not be found, or may be uncomfortable; and pelvic floor exercises are hard to keep up with. But trying a pessary still leaves all the other options open and it might be just what you are after.

read full article

Featured

 Pessaries for vaginal prolapse: Critical factors to successful fit and continued use

The vaginal pessary is an important component of a gynecologist’s armamentarium. It is a low-risk, cost-effective, nonsurgical treatment option for the management of POP and genuine stress urinary incontinence (SUI). It is unfortunate that training in North America typically provides clinicians with only a cursory experience with pessary selection and care, minimizing the device’s importance as a viable tool in a practitioner’s ongoing practice. In fact, most clinicians tend to view the pessary with a mixture of reluctance and disregard.

 Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

Daily self-management of cube pessaries was found to be a safe and effective treatment for improving POP-related symptoms and QoL in the long term.

 Understanding prolapse, the use of pessaries and the impact on the microbiome

Pessaries are an option for women who either want to avoid or delay surgery, and they are also suitable for those whose health conditions make surgery risky. Currently, there is no standard definition for a successful pessary fit. Other lifestyle interventions include weight loss, reduced caffeine intake, and physiotherapy.

Articles of Interest

A pessary for prolapse can be "lifechanging"....

A number of people whom I have supported to use a pessary have commented and/or emailed me afterwards to tell me how it has given them their life back. Fitting a pessary is one of the most rewarding aspects of my job! The pessaries we use are usually made of soft silicone. They are placed within the vagina, and help support the vaginal walls and uterus (womb) in an improved position. Therefore relieving bothersome symptoms such as pressure, bulging and difficulty emptying bladders and bowels. They can be a safe, long term management option for vaginal prolapses.

Adverse events in women with neglected vaginal pessaries for pelvic organ prolapse: a case report and literature review

The vaginal pessary is a simple, economical, safe and effective conservative treatment for symptomatic pelvic organ prolapse (POP). It rarely causes serious adverse effects of urethra, rectum and reproductive system, such as urinary retention, pessary impaction, urogenital fistula, malignant tumor. The occurrence of these rare complications is almost entirely related to long-term wearing and improper care.

Commonly used pessary types – a practical guide

Pessary selection and sizing is often more of an art than a science. However, there are several factors that may be considered when selecting a pessary. These include the shape of the vagina, the severity of the pelvic organ prolapse, whether the patient would like to selfmanage her pessary and if she wishes to commence or maintain sexual activity

Expert Opinion: Vaginal Pessaries in the Management of Pelvic Organ Prolapse

Pessaries are classified as either support or space-occupying pessaries. Most are made out of silicone, but some may be made from latex in which case it is essential to check for latex allergy prior to insertion. Silicone is hypoallergenic and can be autoclaved.

How is a pessary like a sports bra?

You wouldn’t exercise without a sports bra- what can pessaries do for your movement?

Pelvic organ prolapse: Learn More – Pelvic floor exercises and vaginal pessaries for pelvic organ prolapse

Well-fitting pessaries can support the pelvic organs in a way that reduces bladder and bowel problems or even makes them go away completely. They don’t fix prolapses. But women don’t always find a suitable pessary that is effective enough. Pessaries are recommended if, for instance, a woman wishes to avoid or delay surgery. About half of all women who use a pessary get by with it so well that they use it for several years. Pessaries can also be a good idea if pelvic floor exercises don’t help enough on their own.

Pessaries 101

The most common use of a pessary is to provide support to the structure that is protruding into the vaginal canal. Think about it like a strong net that is holding contents up. When your pelvic floor muscles are too tight or weak or both of these classifications, this can cause dysfunction in the pelvic floor where the structures from the abdominal and pelvic cavity start to protrude downwards. The pessary is the net that is being used as a bolster to help perform the job of the ligaments in the pelvis and pelvic muscles to keep the structures above in place.

Pessaries are still a taboo topic – but these ancient devices help many women

Pessaries have been around for a very long time, the oldest known pessary – as described by the ancient Greek physician Hippocrates – was a pomegranate soaked in vinegar! Nowadays, pessaries are made from silicone which is non allergenic, long lasting, pliable and can be sterilised. Some are worn continuously for weeks, months or years with appropriate maintenance, while others are inserted as needed.

Pessaries – are they just for old ladies who can’t have surgery?

Let me say it again: Pessaries are an invaluable tool in the management of prolapse! And this is regardless of the age of the patient. In fact, using a pessary with a younger woman who wants to exercise more vigorously can be a ‘mood saver’ for her. Many women come to me and say ‘I get so depressed when I can’t run’ and putting in a pessary, even just for the exercise session, can provide the necessary support to allow that running to happen.

Pessaries – One Easy Way to Manage Prolapse

Pelvic organ prolapse or vaginal prolapse and urinary incontinence are medical problems that women of any age can have, but are more common for older women. Pelvic organ prolapse, also known as vaginal prolapse, is a condition where women feel a bulge in their vaginal area because her uterus (or womb) or walls of the vagina have weakened and lost support. Women are bothered by the bulge they feel or by losing control of their urine. While there are many ways to treat a bulge in the vagina and leaking of urine, using a device called a pessary is one of the easiest ways to treat these problems.

Pessaries: A Time-Tested Solution for Pelvic Organ Prolapse

Pessaries are among the oldest medical devices still in use, with their origins tracing back to ancient Greece. Today, they remain a cornerstone in the conservative management of pelvic organ prolapse (POP), offering women a minimally invasive and effective alternative to surgery.

The history and usage of the vaginal pessary: a review

It is expected that with the rising female life expectancy the prevalence of pelvic organ prolapse will increase. From ancient times mechanical devices have been used to reposition prolapsed organs. Given that surgical correction of prolapse is associated with high recurrence rates, pessaries offer a favorable alternative. In spite of the antiquity of pessary usage the evidence for its use, the effectiveness of symptom relief, and the nuances of clinical management with the pessary in situ have not been studied methodically. There is a need for controlled trials to assess the efficacy of pessaries as opposed to other non-surgical and surgical methods of treating pelvic organ prolapse

The Plug on Pessaries!

Are you a woman with symptoms of vaginal bulging/heaviness/protrusion? Do you have a prolapse but want to avoid surgery? Urinary leakage that hasn’t completely resolved with pelvic floor exercises? A pessary may be the answer.

Vaginal Pessary for Pelvic Organ Prolapse

A vaginal pessary is a removable device that is placed in your vagina to support the weakened and prolapsed walls of the vagina or uterus. Different types of pessary are available: ring pessary with or without support, gellhorn pessary and a cube pessary are the most commonly used types of pessaries. Some pessaries such as ring pessaries can safely remain in the vagina for several months without removal.

What are the different types of pessaries?

Pelvic organ prolapse (POP), also known as vaginal prolapse is when one or more of a woman’s pelvic organs slip down from their normal position.1 There are many treatments for POP, but a conservative option is vaginal pessaries. They are removable devices inserted into the vagina to support the pelvic floor and attempt to restore the prolapsed organs back to their normal positions.2 Pessaries are generally made of inert plastic or silicone to prevent odours or absorption of vaginal secretions and are available in a wide variety of shapes and sizes.

What is a Vaginal Pessary and Why Might You Need One?

The use of vaginal pessaries to support pelvic organ prolapse dates back centuries and was written about in the Egyptian Papyri, the world’s oldest documented medical literature. Over a century later, Hippocrates and his disciples are attributed with soaking pomegranates halves with wine or vinegar and placing them in the vagina to support the internal structures. Historically, pessaries have provided a low-cost and safer alternative surgery and in modern times they can be used for women for whom surgery is either not possible or desired.

Resources

Pessary Medical Supply

A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes.