When Something Is Coming Out “Down There”-Use of A Pessary To Treat Vaginal Prolapse

As women reach menopause, many women experience changes in the vagina which include incontinence of urine and pelvic organ prolapse where organs and tissues start coming out of the vagina. For mild problems of incontinence, Kegel exercises can help control the problem. For more extensive prolapse surgery is often necessary. For women who can’t have surgery or wish not to take the surgical option, a pessary is an alternative. This blog will discuss a vaginal pessary and how it can help women with urinary incontinence and vaginal prolapse.

A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of 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

Your physician will fit your pessary to 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 health professional’s office. You may need to experiment with different kinds of pessaries to find one that feels right for you. Your health professional will teach you how to remove, clean, and reinsert the pessary on a regular schedule. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary. If it is hard for you to remove and replace your pessary, you can have it done regularly at your doctor’s office.

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.1

Risks
Possible complications from wearing a pessary include:

· Open sores in the vaginal wall.
· Bleeding.
· Wearing away of the vaginal wall. In severe cases, an opening (fistula) 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. Your pessary should be checked frequently by your health professional until both of you are satisfied with the fit.

In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.

Follow your health professional’s instructions for cleaning your pessary, because regular cleaning reduces the risk of complications. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of 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: Incontinence and prolapse are common concerns of many middle age, post-menopausal women. Certainly medications are a first line of treatment. For women who do not respond to medication and do not want to have surgery, a pessary is treatment option.

When Things Are Coming Out “Down There”-Pelvic Organ Prolapse

Pelvic organ prolapse is a common that affects more than 30 million American women in the United States.  Unfortunately, only 15% of women who have prolapse seek treatment from a doctor.  This article will define prolapse, discuss the symptoms of prolapse and discuss some of the treatment options.

Pelvic organ prolapse is a condition where there is a weakening of the support tissues or muscles of the pelvis.  The symptoms of POP include a bulge or lump in the vagina or a pulling or stretching sensation in the groin.  Women with POP may complain of difficulty with sexual intimacy.  They may also have urine and\or fecal incontinence.  They may also have difficulty with bowel movements or difficulty emptying their bladder.

The causes of POP include menopause, multiple pregnancies and childbirth, prior pelvic surgery, obesity, and as a consequence of the aging process.

Treatment options for POP

Conservative therapies including strengthening the pelvic floor muscles.  This can be easily accomplished with Kegel exercises.  These are exercises named after the doctor who devised the treatment, which consists of contracting and relaxing the muscles in the pelvis.  These are the same muscles which hold urine in and rectal gas in place.  A woman should do the Kegel exercises multiple times a day and should not expect any changes for several months until the muscles are strengthened.

For more information on Kegel exercises go to http://www.neilbaum.com/pelvic-exercises-for-women-kegel-exercises.html.

Another conservative therapy is the use of pessaries or plastic or rubber rings which are inserted into the vagina to restore the fallen organ back into the normal anatomic position.   Peccaries will work immediately but they have to be changed periodically in order to avoid vaginal infections.

Probably the most common treatment is surgical repair of the prolapse.  The surgery is used to strengthen structures around the vagina to maintain support of the structures and organs in the pelvis.  These procedures can usually be accomplished through the vaginal opening.  Most women can have the procedure on a one-day stay basis or remain in the hospital for just 24 hours.  Most women need little or no pain medication after the procedure and can return to all activities including heavy lifting, exercise, and sexual intimacy in 3-4 weeks after the procedure.

Most of the surgical procedures that restore the normal anatomy are 90% successful and most patients are very satisfied after the procedure.

Bottom Line:  If something isn’t right “down there” you don’t have to suffer in silence.  There are several treatment options to restore your normal anatomy.  You can have an improved quality of life and return to your normal activities within a short time.  If you have any questions, call your doctor.

 

 

 

 

When Things Aren’t Right “Down There”-Pelvic Organ Prolapse

This is a common condition that affects millions of American women. It is a condition that occurs when one of the pelvic organs such as the uterus, bladder, intestines, or rectum protrudes through the vagina. Prolapse ranges from mild to severe levels where mild prolapse is found by the doctor at the time of a pelvic exam and a severe condition when the organs protrude the vaginal opening and is visible and can be felt by the women when she is in the standing position.

Prolapse is caused by a weakness in the muscles and support structures in the vagina that normally hold the pelvic organs in place and when weakened allows one of the organs such as bladder or uterus to drop into the vagina and when severe protrudes through the vaginal opening. The process of childbirth through the vagina stretches the vaginal muscles and supporting structures and weakens the vagina and allows the organs to drop into the vagina. Each additional vaginal delivery adds more stretch and leads to the potential for more prolapse. Also aging and the accompanying estrogen deficiency also promotes weakness of the vaginal muscles and promotes prolapse. Less common causes include obesity, asthma, bronchitis and other pulmonary conditions that are associated with chronic coughing.

Symptoms of Prolapse?

The most common symptom of prolapse is a feeling of pressure in the vaginal or rectal area. Women often describe a sensation as if they have a ball in the vagina. If the prolapse is severe, the woman can see the lump protruding from the vagina. If the protrusion is present all the time, the tissue can be come irritated and be associated with a discharge or bleeding. With more severe degrees of prolapse it may be difficult to urinate because the urethra, the tube that transports urine from the bladder to the outside of the body, becomes kinked causing the women to strain in order to empty the bladder. In rare situations the woman may be unable to urinate and have to go to the emergency room to have a catheter inserted. Occasionally, prolapse is associated with urinary incontinence especially when the woman coughs and sneezes. Sexual problems include irritated vaginal tissues and painful intercourse. When the rectum prolapses through the vagina, there may be a problem of constipation and the woman may have to insert her finger in the vagina to express the stool. With very severe prolapse the tubes from the kidney to the bladder or the ureters are kinked and can cause obstruction and lead to kidney failure if the prolapse is not repaired.

Treatment of Prolapse

There are two treatment options for prolapse especially if the prolapse is producing significant symptoms. These are the insertion of a pessary or surgical correction.

A pessary is a device that is usually made out of a plastic substance and is usually in the shape of a donut or ring. It is placed in the vagina, like a tampon, to restore the organs to their normal position. Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections.

If a pessary works, and it is comfortable, it can be a lifetime treatment. It can be left in place for several months at a time, however, it needs to be removed and cleaned and then reinserted.

Surgery to correct prolapse is indicated if there are significant symptoms such as a protrusion that is uncomfortable or causes vaginal bleeding, for women who have difficulty with urination such as straining to urinate or urinary incontinence, or chronic constipation. If the uterus is prolapsed it may be necessary to have a hysterectomy as well as repair the prolapse. In addition, it may be necessary to repair incontinence. Most of the surgery is performed through the vagina and can be done on a one-day stay basis or with one overnight stay in the hospital. Women have to avoid heavy lifting for 4-6 months after the surgery and must abstain from sexual intercourse for a similar time period. The surgery is successful in most cases and restores the quality of life to those who suffer from this common condition.

For additional information please visit my website, www.neilbaum.