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Vaginal pessaries
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 health professional 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. See a picture of how a
pessary should fit.
Pessaries can be used successfully to treat other gynecologic conditions, such as a uterus that is in the wrong position.
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.
Complete the special treatment information form (PDF)
(What is a PDF document?)
to help you understand this treatment.
Citations
Clemons JL, et al. (2004). Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. American Journal of Obstetrics and Gynecology, 190(4): 1025–1029.
Other Works Consulted
Liang CC, et al. (2004). Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstetrics and Gynecology, 104(4): 795–800.
Weber AM, Richter HE (2005). Pelvic organ prolapse. Obstetrics and Gynecology, 106(3): 615–634.
WebMD Medical Reference from Healthwise
ENABLEX is a prescription medicine used in adults to treat the following symptoms due to a condition called overactive bladder:
- · having a strong need to go to the bathroom right away (also called "urgency")
- · leaks or wetting accidents (also called "urinary incontinence")
- · having to go to the bathroom too often (also called "urinary frequency")
IMPORTANT SAFETY INFORMATION
You should not take once-daily ENABLEX if you have certain types of stomach problems, glaucoma, or have trouble emptying your bladder. Side effects of ENBLEX include blurred vision, and more commonly dry mouth, constipation, indigestion, and abdominal pain. Use caution when doing certain activities until you know how ENBALEX affects you.
Indication
Uroxatral® (alfuzosin HCl 10 mg extended-release tablets) is an alpha1-blocker for the treatment of the signs and symptoms of BPH.
Important Safety Information
Do not take UROXATRAL if you have liver problems or if you are taking antifungal drugs like ketoconazole or itraconazole, or HIV drugs like ritonavir.
UROXATRAL can cause a sudden drop in blood pressure, especially when starting treatment. This may lead to fainting, dizziness, and lightheadedness. Do not drive, operate machinery, or do any dangerous activity until you know how UROXATRAL will affect you. This is especially important if you already have a problem with low blood pressure or take medicines to treat high blood pressure. There may be an increased risk of low blood pressure and fainting when taking UROXATRAL in combination with blood pressure medication or nitrates, or erectile dysfunction medication.
If considering cataract surgery (clouding of the eyes), tell your eye surgeon that you are currently taking UROXATRAL or have previously been treated with an alpha-blocker.
Before taking UROXATRAL, tell your doctor if you have kidney problems.
Also, tell your doctor if you or any family member(s) have or take medications for a rare heart condition known as congenital prolongation of the QT interval.
BPH and prostate cancer can cause the same symptoms. However, UROXATRAL is not a treatment for prostate cancer.
The most common side effects with UROXATRAL are dizziness, upper respiratory tract infection, headache, and tiredness.
Please see UROXATRAL full prescribing information.
