Have you ever felt bulging in your vagina or pressure pushing toward your legs when standing or straining? Do you have the frequent urge to pee or leaking when active that wasn’t a problem before? Many women experience troubling issues like this but don’t understand what’s happening inside. You may have pelvic organ prolapse – a condition where pelvic muscles and tissues weaken, allowing organs to drop and bulge into the vagina. A pessary is a simple, removable device that offers relief by providing internal support without surgery’s risks. Read on to discover everything you need to know about managing prolapse or incontinence with this surprising yet straightforward solution.
What Is a Pessary and Why Consider One?
A pessary is a removable device inserted into the vagina to provide support and lift to pelvic organs. Pessaries offer a nonsurgical way to manage troubling symptoms associated with pelvic floor disorders like prolapse or incontinence. They can provide life-changing symptom relief for many women avoiding or delaying surgery.
If you are plagued by bothersome pelvic issues, a properly fitted pessary may help restore comfort and function without the risks of an operation. Read on to discover all the essential details about this surprising yet straightforward solution.
Causes of Pelvic Floor Disorders
To understand why a pessary can help, it’s important to first comprehend what leads to pelvic floor troubles. The group of muscles spanning the base of your pelvis is known as the pelvic floor. These muscles and connective tissues act as a hammock, supporting organs like the bladder, uterus, and rectum in proper position.
Certain experiences weaken your pelvic floor over time, allowing organs to slip downward into the vagina. Known as prolapse, this organ movement leads to pressure, fullness, and protrusion. Childbirth, aging, excess weight, and strenuous activity all contribute to pelvic floor damage. Additionally, factors like chronic cough, constipation straining, and prior pelvic surgery further elevate your risk.
As pelvic floor muscles stretch and weaken, you may develop prolapse disorders impacting the:
- Bladder (cystocele)
- Uterus (uterine prolapse)
- Rectum (rectocele)
- Small intestine (enterocele)
Moreover, injury to muscles around the urethra can result in stress urinary incontinence. This involves urine leaking with physical activities like coughing, sneezing, laughing, or exercise. Both prolapse and incontinence severely undermine quality of life.
Why Try Pessary Before Surgery?
There are two main routes for treating troubling pelvic floor disorders: pessary use or surgical repair. Pessaries offer a conservative first-line option for managing symptoms without the risks of an operation. There are many reasons why pessary may be the best initial choice for you:
- Fast relief: Pessaries provide near-instant improvement once fitted and placed properly. You’ll likely notice a reduction in symptoms right away rather than waiting through healing from surgery.
- Inexpensive: Pessary use avoides high surgical costs and hospital fees. Fitting and follow-up appointments tend to cost significantly less than surgery.
- Reversible: If a pessary ends up not being the right solution for you, simply remove it. Surgery, on the other hand, permanantly alters anatomy.
- Low risk: Pessary risks include discomfort, bleeding, or discharge/infection. However, these side effects usually resolve quickly once the device is removed. Surgical complications like pain or bladder injury rarely occur but have more severe consequences if they do.
- No downtime: You can get right back to normal life with a pessary unlike healing for weeks after an operation. There are no activity restrictions or recovery period.
- Option to postpone surgery: Even if you end up needing surgery eventually, trying pessary first delays the operation. This prevents premature surgical intervention before absolutely necessary.
- Suitable if surgery unwise: Underlying health issues making surgery hazardous? Pessary acts as an alternative for those unable to undergo an operation safely.
- Supplement other treatments: Using pessary along with pelvic floor physical therapy provides added support during muscle rehab. This further reduces prolapse or leakage severity.
- Manageable self-care: Many pessary varieties allow self-removal for regular cleaning and intimate relations. Lend a sense of control over the device.
- Covered by insurance: Most insurance plans cover pessary fitting and ongoing care making it affordable for many. Surgery may require high deductibles or copays.
With all these advantages in mind, pessary is an excellent first choice before considering surgery. There’s little to lose by trying it, and so much discomfort to potentially gain relief from!
How Pessaries Ease Discomfort
Wondering how exactly a pessary alleviates pelvic distress? The device works through mechanical support, fitting snugly against vaginal walls. This lifts fallen pelvic organs back into proper anatomical alignment, taking pressure off pelvic floor tissues.
Specific pessary benefits include:
- Prolapse Relief: By propping up prolapsed organs, pessaries relieve associated sensations of pelvic heaviness, dragging, pressure, or fullness. They may also decrease urinary issues like increased frequency or urgency caused by protruding organs compressing the bladder.
- Incontinence Improvement: For stress incontinence, pessaries support and close off the urethra so urine doesn’t leak out unexpectedly with physical activities. Reducing leakage prevents embarrassing accidents and pads.
- Sexual Symptom Aid: Relieving organ protrusion makes sex more comfortable by eliminating obstruction. Lifting tissue off the vaginal walls also decreases painful friction during intimacy.
- Bowel Movement Assistance: Rectocele pessaries lift up the rectum, allowing more complete emptying during bowel movements. This minimizes straining and related anal pressure.
- Hernia Help: Some pessaries have enough structural integrity to gently nudge an intestine poking through abdominal wall tissue back into place. This relieves painful hernia symptoms without emergency surgery.
While not a fix for underlying muscle dysfunction, pessaries successfully shore up support where pelvic tissues have grown too lax. The implant lowers prolapse severity and controls associated leaking, pressure, pain, and more.
Pessary Variety and Design Specifics
There are numerous pessary configurations to select from when it comes to shape, size, and structure. The optimal model for you depends on variables like your unique anatomy and disorder details. However, pessaries are broadly divided into support and space-filling groups based on intended effects.
Support pessaries like rings lift underpropped pelvic organs yet leave the vaginal canal open. This prevents a “plugged up” sensation. Space-filling pessaries have more surface area, blocking off space so organs can’t protrude downward. The increased vaginal coverage leads to better control of advanced prolapse in some cases.
Here is an overview of common pessary types including their defining traits:
- Ring Pessary: This donut shape loops around the cervix, cradling pelvic organs above. An open middle leaves the vaginal canal clear. The ring comes in various sizes and softness levels. It works well for mild bladder prolapse and stress incontinence.
- Gellhorn Pessary: Resembling a round diaphragm, this firmer option has a cone-shaped knob protruding from the middle. The flared disk lifts organs while the knob stems mild uterine descent. Helpful for advanced anterior prolapse disorders.
- Donut Pessary: Similar to the ring but thicker, offering more support. An alternative choice those unable to retain the usual ring. The fuller shape may better hold organs in place. Has an open middle like the ring.
- Shaatz Pessary: Features a solid disk sans knob paired with springy outer wire rim. Supportive for rectocele and enterocele cases needing added reinforcement to block downward organ movement.
- Cube Pessary: Hollow box structure with indented sides that suction onto vaginal walls. Offers space-filling support without soft tissue compression. Often helpful for older women with advanced prolapse. Comes in many sizes.
- Gehrung Pessary: Molded with a central support and attached latex membranes that conform. Allows drainage without absorbing moisture. Good for incontinence and mild uterine prolapse support.
- Dish Pessary: Shaped like a deflated balloon, this ultra-thin option pops open once placed, clinging all around vaginal walls. Space-filling without irritation in some cases.
Your medical provider determines optimal shape through an in-office fitting. Expect to try a few picks before discovering what model works best.
In addition to structured devices, over-the-counter pessaries help specifically with stress urinary incontinence. These disposable inserts support urethral tissues to reduce leakage. Options like Uresta, Contiform, and Impressa are available without a prescription. However, custom-fit devices leased by doctors typically control symptoms better long-term.
Pessary Fitting Step-By-Step
Getting set up with a pessary requires an initial fitting appointment then follow-up care. Here is a walkthrough of what to expect when getting your first device:
Pelvic Exam – The process begins with your doctor thoroughly examining pelvic anatomy. By observing prolapse severity and assessing vaginal dimensions, they determine the optimal pessary style and size for you. Sizing in particular must balance sufficient organ support with comfort to prevent erosion.
Pessary Selection – Next comes actually choosing the right model. Your physician will insert options one by one, evaluating effectiveness. You’ll try walking around and coughing to check for dislodging, organ protrusion, and leakage. State any discomfort clearly so alternate picks can be attempted. This testing settles on the properly supportive pessary not causing issues.
Initial Wear Guidance – Once identified, you’ll insert your fitted pessary for wearing home. Your doctor shares pointers about removal, cleaning, and warning signs needing attention. Review discharge expectations plus follow-up timelines before leaving. Most patients grow comfortable self-managing recurring pessary care tasks. However, ongoing oversight ensures proper fit and vaginal health.
Follow-Up Appointments – After getting set up, revisits check device position and fit. Usually pessaries require provider inspection every three to six months. Any bothersome symptoms also warrant earlier evaluation. These recurring visits examine for complications like erosion, infection, or embedment. Your doctor may replace worn pessaries or try alternate sizes as needed. Stay vigilant and speak up about discomfort.
Self-Care Between – Visits Depending on pessary design, some individuals handle cleaning solo through regular removal. After washing with gentle soap then thoroughly rinsing, the device can be reinserted easily. However, confirm self-care details with your physician as certain pessaries only doctors should handle. Tracking changes like new discharge, pain, or slipping helps identify issues requiring off-schedule attention. Overall though, pessaries are low maintenance between fittings.
By conveying needs clearly during selection then closely adhering to usage guidelines after, pessary users often achieve excellent symptom relief. Be patient through short-term trial and error – perseverance pays off!
Pessary Perks: Benefits of Using This Device
Pessaries offer multiple advantages as a first-line treatment before surgery:
- Rapid Relief – Unlike post-op healing, pessaries start easing discomfort promptly once in place. Most patients report significantly improved symptoms within days of fitting. Bid bothersome bladder, bowel, or pelvic concerns adieu!
- Few Risks – Pessaries are quite safe with low complication odds, especially under doctor guidance. Potential but rare issues like new bleeding or pain resolve upon removal. Whereas surgery poses permanent nerve damage, scar tissue, ongoing pain, or mesh complications.
- Inexpensive – Costing far less than an operation, pessary expenses are limited to infrequent fittings and device replacements. Even lacking robust insurance coverage, the price is relatively affordable for most.
- Easy Use – Simple insertion, removal, and no daily upkeep make using pessaries highly convenient. Cleanings may require occasional attention but basic operation is trouble-free.
- Outpatient Option – With pessary placement done right in the clinic, there’s no anesthesia risks, admission fees, or post-discharge recovery. Quickly get back to normal activity sans restrictions too!
- No Permanent Alteration – Should pessary treatment not meet expectations or a better solution emerge, taking it out restores original anatomy unaltered. This avoids permanent changes making future options less effective.
Given these advantages, pessaries serve as an excellent starting point before considering surgery. Why undergo a major operation if a straightforward device fitting may fix everything? Give this game-changing gadget a shot first!
Watching for Complications
While generally safe, pessaries do rarely cause adverse effects needing attention. Many complications arise from poor fit leading to friction and tissue damage. Stay alert for symptoms like:
- Pain/Discomfort – Signaling improper size or position, rectify right away through refitting.
- Bleeding/Discharge – Spotting or colored drainage could indicate erosion into vaginal lining.
- Foul Smell – Noticeable odor suggests infection which requires examination even without other symptoms manifesting.
- Urinary Troubles – New incontinence or increased leaking warrants reassessment.
If discomfort emerges despite proper placement, try an alternate shape or material. For any worrisome changes however, promptly contact your doctor no matter how minimal concerns seem. Left unaddressed, complications risk embedment or abscess formation. Don’t tough out troublesome signs!
Certain medical conditions also contraindicate pessary use completely. Individuals with manual dexterity deficits that limit removal/cleaning capacity may not be candidates. Severe prolapse equally challenging to support along with active vaginal infections means avoiding pessary placement as well until fully resolved.
When utilized responsibly under physician guidance, pessaries offer low hassle relief though. Follow all recommendations to keep this treatment as problem-free as possible!
Pessary versus Surgery: How to Decide
If pessary treatment just isn’t cutting it, surgical reinforcement may become necessary. But when is the right time to transition from conservative management to operative intervention?
Factors favoring eventual operation include:
- Severe/worsening prolapse unimproved through pessary use alone
- Recurrent complications like new bleeding or discomfort
- Unable to tolerate office visits for monitoring
- Seeking more activities without needing to remove device
- Goal of maximal long-term correction over just symptom relief
Before moving to surgery, ensure pessary no longer suffices even with design changes. However, pronounced worsening despite compliant fitting warrants discussion regarding reinforcing options. Your doctor can advise on optimal timing for rescue surgery when conservative steps cease adequately controlling issues.
Waiting too long risks discomfort, sexual dysfunction, plus complications like ulcer formation. Alternatively, premature surgery exposes you to unnecessary operative risks if symptoms were still manageable.
Have an open dialogue with your pelvic health clinician regularly revisiting quality of life plus disorder progression. Transition from pessary to surgery at the ideal moment – not too soon yet not too late either! Walk this treatment tightrope advisedly.
The Takeaway: Who Benefits Most from Trying Pessary?
Pessaries empower motivated patients ready to partner closely with providers on fitting details plus self-care. Committing to follow-ups and promptly reporting issues ensures satisfactory results. Additionally, individuals wanting to delay surgery as long as possible make great candidates. However, moderate your expectations understanding pessaries control rather than correct pelvic dysfunction long-term in severe cases.
All things considered, a pessary presents low risk yet high reward. Why undergo intensive surgery first before exploring such an easily reversible option? Give this discreet device a shot at reviving your quality of life today!