Stress urinary incontinence or loss of urine with coughing, sneezing, or even bending over to put on your shoes affects millions of American women. Often times a woman is looking for a treatment that does not involve medication or surgery. For certain women a vaginal pessary is an option. A pessary is a removable device placed into the vagina. It is designed to support areas of the pelvis such as occurs with pelvic organ prolapse.
There are a variety of pessaries available, made of rubber, plastic, or silicone-based material. Among common types of pessaries are the inflatable , the doughnut, and the Gellhorn.
Frequent Urination: Causes and Treatments
Gotta go all the time? The technical name for your problem is frequent urination or overactive bladder. In most people the bladder is able to store urine until it is convenient to go to the toilet, typically four to eight times a day. Needing to go more than eight times a day or waking up in the night to go to the bathroom could mean you’re drinking too much and/or too close to bedtime. Or it could signal a health problem.
Why It Is Done
Pessaries are used as a nonsurgical approach to the treatment of pelvic organ prolapse. They are frequently used to treat uterine prolapse in young women during pregnancy. In this instance, the pessary holds the uterus in the correct position before it enlarges and becomes trapped in the vaginal canal.
Pessaries are also used when symptoms of pelvic organ prolapse are mild or when childbearing is not complete. They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous.
Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a “pessary test.” If you have a problem with incontinence with a pessary inserted, a separate surgery to fix the incontinence problem may be done at the same time as a prolapse surgery
How Well It Works
Pessaries do not cure pelvic organ prolapse but help manage and slow the progression of prolapse by adding support to the vagina and increasing tightness of the tissues and muscles of the pelvis. Symptoms improve in many women who use a pessary, and for some women symptoms go away.
You will need to see a doctor to be fitted for a pessary which will hold the pelvic organs in position without causing discomfort. Pessaries come in a variety of sizes and should be fitted carefully.
What To Expect After Treatment
Your pessary will be fitted in your doctor’s office. You may need to experiment with different kinds of pessaries to find one that feels right. The pessary needs to be remove, clean, and reinsert the pessary on a regular schedule. Most often this is done by the doctor or his\her staff but some women prefer to do this themselves. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary.
Possible complications from wearing a pessary include:
• Open sores in the vaginal wall.
• Wearing away of the vaginal wall. In severe cases, an opening can form between the vagina and the rectum.
• Bulging of the rectum against the vaginal wall (rectocele formation).
Complications can be minimized by having a pessary that fits correctly and that does not put too much pressure on the wall of the vagina.
In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.
What To Think About
Pessaries often are an effective tool for managing pelvic organ prolapse without surgery. They may be the best choice if you are a young woman who has not finished having children, if you have been told that surgery would be risky for you, or if you do not wish to have surgery for other reasons.
A pessary may not be a good choice after having a hysterectomy. This is because the walls of the vagina are no longer held in place by the uterus and cervix. Women with severe prolapse following a hysterectomy may have difficulty keeping the pessary in place.
Many women can have sexual intercourse with their pessary in place. But you cannot insert a diaphragm (a round rubber device used as a barrier method of birth control) while wearing a pessary. If you have not reached menopause, you may want to discuss birth control with your doctor.
Bottom Line: Stress incontinence is common condition affecting millions of American women. The treatment with a pessary is an option that does not require the use of medication or surgery.
For more information on women’s health, I suggest my new book, What’s Going On Down There-Everything You Need To KnowAbout Your Pelvic Health. the book is available from Amazon.com