Vaginal Pessary for Prolapse: Types, Care and Risks

Vaginal pessary for prolapse is used in the treatment of the pelvic organ. What is its function? What care does it require? Find out!

The vaginal pessary is a device that has been used for a long time in gynecology. It is designed to treat pelvic organ prolapse through the vagina. For example, uterine prolapse, bladder, rectal, etc.

These conditions occur when the muscles and ligaments that support these organs become weak. This often happens after undergoing pelvic surgeries or birthing multiple kids. And while the vaginal pessary is a very useful form of treatment, it requires certain considerations before it is used. Keep reading!

What is a vaginal pessary?

A vaginal pessary for prolapse is a device you insert in the vagina. Its function is to support the pelvic organs that prolapse into it. To understand it, it is important to explain what the pelvic floor is.

The pelvic floor consists of three compartments. The superior comprises the bladder and the urethra. Both organs can prolapse into the vagina, called a “cystocele” and “urethrocele,” respectively.

The central compartment is formed by the vagina and the uterus. In this case, a prolapse of the uterus itself, or even of the vaginal vault, can occur. Finally, the rectum can also prolapse into the vagina, giving rise to a “rectocele.”

Prolapses are very common in women. The reason is that the pelvic floor can be weakened for multiple reasons. For example, due to prolonged or instrumental deliveries, pelvic surgeries, multiparity, etc.

Other aspects such as obesity, age or even genetic predisposition also have an influence. A vaginal pessary does not allow to cure prolapses as such; however, they do help control them and slow their progression.

They work as if they were a support for the vagina itself. Thus, they increase the firmness of the muscles and tissues of the pelvic floor. If used properly, they can be a good treatment option for many women. However, they can also cause complications.

What is it used for?

When the symptoms of a vaginal prolapse diminish the quality of life, it is convenient to use a vaginal pessary.

A vaginal pessary is a device that makes it possible to treat pelvic organ prolapse without resorting to surgery. As a publication in Trials explains, they are used when the symptoms of prolapse are mild. Also in those women who still want to have children or during pregnancy.

The idea of using this element in pregnancy is to try to keep the uterus in a proper position. Sometimes, the enlargement of this organ causes it to move towards the vagina. This can lead to its entrapment and complicate the pregnancy.

Pessaries are recommended for women who are at high risk for any surgical procedure. For example, if they suffer from chronic diseases, such as heart disease.

On the other hand, they can be used to check whether surgery is indicated or not. Prolapses often result in urinary incontinence. When placing a pessary, this should disappear.

However, incontinence may be caused by other causes. If so, the placement of the pessary would not fix it. Therefore, it serves to discern which cases of incontinence are operable and which are not. This is called the “pessary test.”

Different types of vaginal pessary for prolapse

Most pessaries are made of silicone. The size varies depending on age and vaginal length. Typically, young women need larger than older ones, for reasons of comfort.

As explained by specialists, there are different types of pessaries depending on their shape and characteristics. First, we find the ring-shaped vaginal pessary. It is the most used in those women who suffer mild prolapses.

On the other hand, there is the donut type. They are indicated when the prolapse is more severe. There is also the incontinence pessary, which is used when there is stress urinary incontinence (when coughing, laughing or bending over).

How to insert it?

Before inserting a vaginal pessary, a physical examination of the woman should be performed. As explained in an article by the International Urogynecological Association, it is essential to carry out a gynecological examination in which the type of prolapse is evaluated.

During it, the vagina should be measured to decide what is the most appropriate size of the element. This should be as accurate as possible; also, it should not be inserted beyond the vagina if it is too large.

When its size is smaller, it can come out when urinating or defecating. You may need to try several different sizes to find the most suitable vaginal pessary.

To insert it, the ideal is that gloves are used or that the hands are clean and disinfected. The same should happen with the device. In addition, the element must be changed and serviced frequently.

It is recommended that, at least every three or six months, the woman go for a check-up with the gynecologist. In some cases, the replacement of the pessary can be carried out by the woman herself.

However, there are others that have a special placement or that are not designed for long periods. Therefore, it should be the doctor who recommends what is best in each specific case.

Possible risks and side effects

It is important to consult with the gynecologist all doubts before the pessary is placed.

Despite their benefits, these devices are not without risks and complications. As a study published in Clinic and Research in Obstetrics and Gynecology explains, pessaries can cause wounds in the vaginal wall.

In turn, this can lead to pain and bleeding. The vaginal wall can progressively wear away, causing an abnormal communication to form between the vagina and the rectum. It is the so-called “rectovaginal fistula”. They can even appear between the bladder and the vagina (vesicovaginal fistulas).

Being a foreign body in the vagina, it is likely that the secretion in this area will increase. In the same way, the risk of suffering infections increases. For example, by Actinomyces. The inflammatory process can give rise to cellular alterations with the potential for malignancy.

In some cases, although very rarely, the vaginal pessary has been associated with peritonitis and other intestinal complications. It has also been seen that it can be impacted in the vagina.

Care and recommendations

Wearing a vaginal pessary requires taking into account certain aspects. The first thing is that a woman may have to try several different types and sizes until she finds the right one. In addition, many times they must be the ones in charge of removing it, cleaning it and putting it back on.

However, if there are difficulties in carrying out these maneuvers, they can be performed in a doctor’s office. Also, depending on the type of vaginal pessary used, it may need to be left in place during sexual intercourse.

This can interfere with comfort and the way of choosing the most appropriate contraceptive method. If complications appear, such as sores or wear on the vaginal wall, the recommendation is to remove the device. The ideal is to stay without it for about two or three weeks.

In addition, estrogens and lubricants are often prescribed to apply to the area. Estrogens help the vaginal epithelium to stay strong and rebuild itself. They can be given as creams, rings, or tablets.

When cleaning the vaginal pessary, you must follow all the instructions of the doctor and the brand. This reduces the risk of vaginal infections.

What you must remember

A vaginal pessary is a device used to treat pelvic organ prolapses. For example, when the uterus, bladder, or rectum pushes through the vagina. It is a good treatment option in women in whom surgery is contraindicated. They are available in different sizes and types.

However, they can cause injury, discomfort, and other complications. Therefore, you should always follow the instructions of a doctor. It is also important to go frequently to gynecological check-ups.

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