In some women the pessary works well with respect to holding their organs in place, but it “unmasks” incontinence. This means that when you use the pessary you start to leak urine. When that happens the choice is to not use the pessary, live with the prolapse and remain dry or have surgery.
Pelvic organ prolapse affects 40% of women over 40 years. Pessaries are often used as a first-line treatment and give high patient satisfaction. Complications of pessaries are rare, but vaginal erosions can lead to adhesions, haemorrhage, impaction and migration.
You may notice an increase in vaginal discharge or secretions with pessary use. However, the pessary is made of silicon rubber and does not absorb odors or secretions. The Center for Urogynecology and Women's Pelvic Health recommends only external cleansing.
They are designed to support the urethra and bladder wall, increase urethral length, and provide gentle compression of the urethra against the pubic bone. This structural arrangement reduces and often prevents leakage when intra-abdominal pressure increases, essentially resolving the problem of incontinence.
The pessary is inserted into the vagina in a vertical position and once inside the vagina released to assume a horizontal position. A correctly sized pessary should allow a finger to be passed easily around the circumference of the pessary.
A well fitting pessary will not cause pelvic discomfort when standing up and walking. When you cough, bend forwards, squat or hold your breath and strain the device should not move down out of your vagina. If the pessary moves to the entrance or out of your vagina you may require refitting with a larger size.
Most women will have an increase in discharge with the pessary in place. The discharge can smell bad. Sometimes, the pessary can cause incontinence of urine.
Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium chloride.
Pessaries do not cause infections, but you might notice a whitish or yellow discharge from your vagina. This is OK. However, if the amount of discharge increases or has an odor, call your provider. If you see vaginal bleeding, call your provider-you might have an ulceration.
In all of these studies, the pessary was cleaned or replaced regularly every 3 or 6 months.
How long can I use a pessary for? Pessaries are a safe long-term treatment for prolapse but they do need to be changed every three to six months. Some women will be able to do this at home themselves but others will need to go to a hospital or a clinic to have this done for them.
When you choose a pessary for the right patient, evidence shows that about 75 percent of these patients will report improvement in their prolapse symptoms.
6. If it does not feel comfortable, use your index finger to gently push it in a little farther. You can't hurt yourself or the pessary doing this. The rim of your pessary should sit just under the pubic bone at the front of your vagina.
Physicians can offer pessaries to the majority of patients with prolapse because there are very few contraindications. However, rates for successful pessary fitting range from 41 to 86 % [9–16], indicating that pessary treatment is not suitable for all women.
Causes of urinary incontinence
Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter. Urge incontinence is usually the result of overactivity of the detrusor muscles, which control the bladder.
When to see a doctor. You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, it's important to seek medical advice because urinary incontinence may: Cause you to restrict your activities and limit your social interactions.
Incontinence can happen for many reasons, including urinary tract infections, vaginal infection or irritation, or constipation. Some medications can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to: Weak bladder or pelvic floor muscles.
In a prospective, self-controlled clinical trial published in Investigative and Clinical Urology in March 2022, Mayo Clinic investigators found that both pessary use and surgery for pelvic organ prolapse improved symptoms. However, patients deemed the degree of improvement more significant for surgery.
A pink or bloody discharge could mean the pessary is rubbing against the wall of the vagina. In most cases, removal will allow the area to heal. In cases of bleeding, a visit to a nurse or doctor is needed. White-colored discharge from the vagina is common with pessary use.
Pessaries need moisture in the vagina to dissolve completely. If they do not dissolve, pieces of the pessary may crumble and fall out of the vagina. You may notice this if you have vaginal dryness. To help the pessary dissolve, insert it as far as possible into your vagina at bedtime.
The most common side effects of pessary use are a foul smell, vaginal discharge, bleeding, pain and constipation [43].
To insert into the: Vagina - place the pessary between the lips of the vagina and push the pessary upwards and backwards. You may find it easier to do this if you are lying down or squatting. Rectum (back passage) - gently push the pessary into the rectum for about one inch.
(c) Otherwise if there is no applicator supplied, you can insert the pessaries using your fingers. Note: During pregnancy, the pessary should be inserted without using an applicator.