Pessary at a glance
- A pessary is a small removable device that is inserted into the vagina to provide support for vaginal tissues that hold the pelvic organs in place.
- Patients with their pelvic organs in the correct place will see improvement in their bladder symptoms, which can include emptying the bladder more easily, reduced urinary leakage and the reduced feeling of pressure from the bladder and vagina.
- It is a cost-effective, nonsurgical treatment that is a good option for many patients suffering from urinary incontinence or pelvic organ prolapse (POP).
- A pessary is a great option for women who would still like to bear a child or who are not a good candidate for surgery for POP or urinary incontinence.
What is a pessary?
A pessary is a nonsurgical alternative treatment for urinary incontinence or pelvic organ prolapse (POP). These devices are becoming increasingly popular, as the population continues to age and women are more commonly being seen for pelvic floor disorders.
A pessary is a small device that can be inserted into the vagina to provide support for vaginal tissues displaced by POP. Once in place, it supports the pelvic organs (uterus, bladder and rectum) and helps to decrease urine leakage and pressure from the vagina. This often allows women to feel more secure when engaging activities.
Other treatments for POP or urinary incontinence include behavioral changes or surgery. Behavior changes include Kegel exercises, physical therapy, diet modifications and weight management.
Surgery is highly effective but is not the right solution for all patients. Women who wish to expand their family in the future are not recommended to have surgery due to the chances of prolapse happening again after childbirth. This leaves the pessary as a great substitution for women who are looking for an option for pelvic support, but still wish to get pregnant down the road. It is also a good alternative to surgery for women with medical conditions, such as heart disease, diabetes or breathing problems, who need to avoid surgery. It’s also an acceptable option for women who prefer a more conservative approach.
Pessaries have been around for hundreds of years. The technology has evolved, and there are now many sizes and shapes available to suit each patient’s needs. The devices are durable because they are made from medical grade silicone, which makes them resistant to absorbing vaginal discharge and odors and causing infections
A 2004 study published in the American Journal of Obstetrics and Gynecology states that after a 2-month study, 92 percent of women who had a successfully fitted pessary were satisfied. During the same study, nearly all prolapse symptoms were resolved, and 50 percent of urinary symptoms improved in the women.
- Patients who are not be eligible for a pessary include:
- Those with an allergy to both silicone and latex
- Women with active pelvic infection or severe ulceration
- Those who are unlikely to follow up with physician visits
Types of pessaries
Vaginal pessaries come in a wide range of sizes and shapes. If fitted properly, a patient will not notice that the pessary is in place. Pessaries are fitted in a trial-and-error process, and it is not uncommon to try several different kinds and sizes in determining the right fit. (It is much like trying on shoes!) The severity of a woman’s prolapse or incontinence, sexual activity and prior surgeries can play a role when finding the pessary that is right for them.
Pessaries fall into two categories: support pessaries and space-filling pessaries.
Support pessaries
are easier for patients because they are more comfortable and simpler to remove and insert. They also tend to be preferred by patients because they have the flexibility to remove them when they wish.
Space-filling pessaries
are primarily used to support severe pelvic organ prolapse, especially when the vagina drops after hysterectomy. Their shape is designed to help them stay in place when pelvic support muscles are weak.
Risks and side effects
A properly fitted and maintained pessary brings very few risks for the patient. Common side effects, including vaginal irritation or odor, are most common when pessaries are not properly maintained. This may also make pessaries more difficult to remove.
In rare instances, more serious complications can occur when a pessary is neglected for long periods of time. A classic example is a patient in a nursing home who has had a pessary in place for many years without proper care. In these instances, the pessary may bury itself in the vaginal wall or nearby organs.
To avoid these problems, women should ensure they follow up for routine care. We also recommend that any woman wearing a pessary communicate this to a significant other, family member or close friend in case a medical emergency such as a stroke should occur, and she is not able to communicate this to a provider.
With proper maintenance and care, the pessary has minimal risks, especially compared with the alternative option of surgery.
Routine care and follow-up for a pessary
A follow-up visit is scheduled for several weeks after insertion. In this appointment the patient will be asked if she has experienced any discomfort, inability to urinate or have a bowel movement, or vaginal discharge or bleeding. During this appointment the physician will remove and clean the pessary, and the vagina will be examined for pressure points, abrasions or erosion. Women who have already gone through menopause or women experiencing irritation due to their pessary can use a vaginal gel or local estrogen to help lubricate the vaginal walls.
If the pessary fits well and the patient is able to manage insertion and removal on her own, she is advised to clean and reinsert the pessary based on individual recommendations. A follow-up exam every 6–12 months or as needed is recommended. For patients who are not able to remove and reinsert their own pessary, a follow-up appointment every 2–3 months is recommended (or based on individual needs)