Category Archives: Pessaries

Pessary Placement

Pelvic Organ Prolapse (POP) is a medical condition through which many women go through. A pessary is majorly used as a treatment for POP, and at times is used for stress incontinence and certain gynecologic conditions. It is inserted into the vagina, and can be removed later.

Types

There are many types of pessaries. They are usually made of silicon or inert plastic, and are valuable in many shapes and sizes, and may be supportive or space occupying. The common types of support pessaries are ring, Smith and Gehrung. Space occupying pessaries include donut, cube and Gelhorn. A suitable pessary type is selected after considering the patient’s history, severity, symptoms, uterus, vagina size and sexual activities. The chosen pessary must be large enough to fit comfortably.

Placement

Before a pessary is inserted, the bladder must be emptied. The pessary is then fitted into the vagina, and the patient must determine if it is comfortable or not. Usually there are no complications associated with pessary placement, and the procedure is simple enough. The patient can do it herself once she gets familiar with it. Pessaries must be cleaned regularly.

It must be mentioned that pessaries are not a cure for pelvic organ prolapse. The only thing that is achieved after a pessary placement is that prolapse progression is slowed down. This happens because pessaries provide vagina with the necessary support, and tighten the pelvis muscles. Prolapse condition is improved in many women, and the symptoms disappear in some women.

Risks

There are certain risks associated with pessaries. The most common of these are:

  • Bleeding
  • The vagina wall may develop open sores or wear away
  • The rectum bulges against the vagina or an opening is formed between them

These risks are minimized if the pessary is chosen appropriately.

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What Is Vaginal Prolapse?

Vaginal prolapse is a medical condition that happens when the structures including the ligament and floor muscles around the pelvis elongate and devitalize, rendering the entire network to be inefficient in supporting the uterus, which in such case, recedes into the canal in the vagina.

Gehrung Pessary

Gehrung Pessary

A woman’s vagina has a complex network of support holding the pelvic tissues, organs, and structures in their proper place. Included in the support structure are fascia, the muscles located on the walls of vagina, and its skin. In a case of a vaginal prolapse, the support structure will fall out from their usual positions.

If left without treatment, the uterine prolapse, another of its terms, will cause the structures to descend farther into the vaginal opening.

Types of Vaginal Prolapse

There are five types of uterine prolapse that can be diagnosed:

  1. Rectocele. Also known as the prolapse of the rectum, the rectocele includes the prolapse of fascia.
  2. Cystocele. This is the bladder prolapse that happens when fascia prolapses. Thus, the bladder will prolapse towards the vagina.
  3. Enterocele. This results when fascia’s front and back separate, causing the intestines to advance against the skin of vagina.
  4. Prolapsed uterus. The prolapse involves the womb, wherein, the ligaments on vagina’s top portion weaken, causing the uterus to plummet.
  5. Vaginal vault prolapse. This type of vaginal prolapse is common after hysterectomy because the uterus also acts as a supporter of the vagina.
Ring Pessary

Ring Pessary

Pessary Device 

A pessary is a medical device used into a vagina to act as a support to the uterus, bladder, vagina, and rectum. In most cases, the pessary device is used to treat women with vaginal prolapse. It is especially helpful if the prolapse is cystocele or a rectocele. It is also helpful for women who suffer from incontinence.

References:

http://women.webmd.com/vaginal-prolapse

http://www.mayoclinic.com/health/uterine-prolapse/DS00700

http://familydoctor.org/familydoctor/en/drugs-procedures-devices/procedures-devices/vaginal-pessary.html

What is a pessary?

You’ve just had a medical check-up and you got some news that dampened your heart – you have suffered a uterus prolapse. However, you were reassured by your doctor that the fitting of a pessary is a good solution to the problem. The question then is what is a pessary?

Well, simply put, a pessary is a medical device that looks like a ring or diaphragm. There are pharmaceutical pessaries and non-pharmaceutical. They are mostly used in the treatment of prolapses either of the rectum, bladder, uterus or vagina. Other health conditions where the use of a pessary becomes necessary includes but not limited to stress urinary incontinence, rectocele, cystocele and retroverted uterus.

The pessary comes in different forms which include the Oval Pessaries which were originally designed as an alternative to Ring Pessaries in an event where the patient’s vaginal vault is not wide enough. It is also mostly used by women who have undergone any type of vaginal surgery or procedures involving bladder suspension. The ring pessaries are wider than the oval pessaries. When it comes to the treatment of second degree cystocele and prolapse, oval pessaries are mostly recommended.

Donut Pessaries are mainly used in the treatment of third degree prolapse which is a common occurrence in women who are within the menopausal age. They are effectively used to tackle cases of severe rectocele, cystocele and uterine prolapse. They are designed with flexible silicone which allows for compression during insertion.

Cube Pessaries which are recommended by experts in cases of uterine prolapse resulting from child birth is another type of pessaries available. This type of pessary is designed mainly for third degree prolapse, but it can also be effectively used in the treatment of rectocele and cystocele. It comes in various sizes, fitted with a tie for easy removal.

When it comes to the use of the gellhorn pessary, they are mainly manufactured for the purpose of being a support should there be a case of prolapse of the small bowel, uterus, rectum or bladder. It can also serve as support in the case of vaginal vault prolapse. It is easily inserted and the same applies to its removal.

During insertion, the knob folds and when it is in position, it rests on the posterior of the vaginal wall. This particular pessary is designed with drainage holes for the purpose of free passage of fluid. To ensure that the medical needs of women of various sizes and age are taken care of, this device comes in several sizes. It is strongly advised that this pessary be removed before you engage in sexual intercourse.

Apart from those functions of pessaries, pharmaceutical pessaries have additional uses. What is the difference? The difference is, while the other pessaries serve as support for one or more organs of the body, the pharmaceutical pessaries are used solely for the purpose of delivering pharmaceutical substances to a given patient’s body which when delivered, the walls of the rectum or vagina easily absorbs them. A pharmaceutical pessary can also be fitted into the vagina to help guard against any form of infection or inflammation of the walls of the vagina.

Now that you know what a pessary is and most of the basic things about it, you can experience relief from rectum, bladder, uterus or vaginal prolapse, rectocele and cystocele through the use of the pessary that suits your condition. Before your doctor proceeds with the fitting of the pessary, he or she is required to verify the size of pessary that will not be too large or too small for you and this is determined by using the Pessary Fitting Kit.

References:

http://en.wikipedia.org/wiki/Pessary

http://www.hystersisters.com/vb2/article_451160.htm