A vaginal pessary is a medical grade plastic ring shaped device that is inserted high up vaginally to support the uterus, vagina, bladder and bowel. It provides effective non-surgical management of pelvic organ prolapse (POP). When properly fitted the pessary can simulate the result of surgical correction of prolapse.
The vagina is a closed tube so the pessary will stay in place and not migrate in the body. If it falls out when you strain or lift, the pessary may be too small, too large, the vagina is too open or short.
Pessaries are used during pregnancy and post birth to support the uterus and help women who experience bladder, bowel and uterine descent and bladder incontinence. As there are many types of pessary supports, a healthcare provider will fit the device according to the symptoms. Often, different sizes are fitted before achieving the best fit and sometimes a different type is fitted later if discomfort presents.
Some vaginal pessaries can be worn during intercourse without discomfort to you or partner. Be sure to promptly report any discomfort or difficulties with bladder and bowel emptying.
Many women learn to remove and insert their pessary daily and clean with soap and water before reinserting. If you are unable to remove the pessary, this can be done at regular check-up appointments.
When the pessary is not regularly removed and cleaned, it may cause a pressure area in the vagina and produce more vaginal discharge. Oestrogen cream is used in conjunction with a pessary to improve tissue quality or relieve irritation.
- The incontinence ring or dish pessaries are commonly used for stress incontinence.
- A Hodge pessary with support is used when a cystocoele is present with stress incontinence.
- The cube and Hodge pessaries are effective in controlling sport related stress incontinence.
- First and second-degree uterine prolapse are managed with a ring, donut or inflatable pessary. The cube pessary (held in place by suction) is designed to manage third degree uterine prolapse. As the cube has no drainage it must be removed daily.
- The Gellhorn pessary is used to manage severe uterine or vaginal prolapse.
- When third-degree uterine prolapse is accompanied by a cystocoele or rectocoele, a Gehrung pessary may be the preferred choice.
- For a large anterior wall prolapse the Gellhorn pessary is often used along with inflatable and cube pessaries.
- For rectocoeles and enterocoeles (small intestinal prolapse) a Gellhorn, donut, inflatable or cube pessary are used to provide support.
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