Pessaries

A pessary is a medical device that can be used to treat multiple gynecological conditions such as stress urinary incontinence and pelvic organ prolapse. Pelvic organ prolapse can represent lack of support of the uterus or of the vaginal walls. There can be combinations as uterine and vaginal prolapse as well.  Vaginal wall defects are named by the location of the defect. Rectocele and enterocele refer to defects in the posterior vaginal wall, near the rectum, while defects of the anterior vaginal wall, near the bladder are called cystocele. Management with a pessary is often considered when surgery is not an option. Each condition can be managed with the correct type of pessary.  There are multiple types of pessaries used to treat the various types of gynecological conditions.

Photo credit: American Family Physician magazine. In order the type of pessaries are: A.) Ring, B.) Shaatz, C.) Gellhorn, D.) GellHorn, E.) Ring with support, F.) GellHorn, G.) Risser, H.) Smith, I.) Tandem cube, K.) Hodge with knob L.) Hodge M.) Gehrung, N.) incontinence dish with support, O.) Donut, P.) Incontinence Ring, Q.) incontinence dish, R.) Hodge with support, S.) Inflatoball.

The ring pessary is commonly used to treat cystocele. For very severe uterine prolapse pessaries such as the cube, donut and Gellhorn can be used. For women that suffer from stress urinary incontinence the most commonly used pessary is the incontinence ring and incontinence dish pessaries.

Pessaries come in different shapes and sizes which require fitting by a medically trained professional. This can require some trial and error. During a fitting an individual should expect a pelvic examination and the insertion of a pessary. The functionality of the pessary is also tested. For example, if the pessary is inserted to control stress urinary incontinence, you will be asked to cough to check for the leakage of urine. You may be asked to sit, stand, squat and to perform the Valsalva maneuver ( pinch your nose closed and blow, like trying to ‘pop your ears” ). This is to ensure that the pessary is the correct fit for everyday functions. Improper fit of a pessary can cause abrasions to the vaginal wall..

When properly fit, you should not be able to feel your pessary. You may notice an increase in vaginal discharge or vaginal odor. If you notice vaginal bleeding or a foul smelling odor you should have the pessary checked. Some women remove their pessary themselves and clean it and reinsert it. Others have it removed and cleaned every 3 to 6 months by their clinician. Care of the pessary is generally washing with soap and water.

References

Jones, K., Harmanli, O. (2010). Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence. Reviews in Obstetrics & Gynecology. Retrieved from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876320/

Viera, A., Pettigrew, M. (2000). Practical Use of the Pessary. American Family Physican, 61(9). Retrieved from https://www.aafp.org/afp/2000/0501/p2719.html