These gynecological conditions are cystocele, enterocele, and rectocele, uterine and vaginal prolapse, including stress urinary incontinence. Although many physicians are unfamiliar with the pessary, it has been a useful device for the nonsurgical management of vaginouterine disorders.
Pessaries are available in different sizes and shapes, but the gynecologic disorders of patients dictate the kind of pessary to use. A doctor with knowledge on pessaries and the different female pelvic conditions that are manageable with pessary use knows the best shape and size to fit a patient.
Pessary Manageable Female Gynecological Conditions
Stress Urinary Incontinence
Urinary Incontinence is the involuntary leaks of urine during physical activities, and when coughing, sneezing, or laughing. The condition is cause by weak pelvic muscles that make the diaphragm bear down on the bladder causing urine leaks.
Other causes of a weakened pelvic floor are brain and nervous system injuries, injuries to the urethral area, surgeries of the pelvic area, and multiple vaginal childbirths.
Vaginal vault prolapse
Vaginal Vault Prolapse happens when the pelvic floor weakens causing a portion of the vagina to drop down into the vaginal canal to the opening of the vagina. Vaginal vault prolapse happens most in women who have had hysterectomy or prolapse of the bladder, urethra, rectum, and small intestine. A vaginal pessary provides support to the weakened vaginal walls.
Cystocele
A cystocele condition can happen because of childbirth. The pressure of labor contractions can tear the tough fibrous wall between the bladder and vagina resulting in a hernia. Then the hernia will move down the vaginal entrance creating a large bulge in the front vaginal wall. The condition makes emptying the bladder difficult.
Enterocele
An enterocele condition is the cause of weakening muscles and ligaments supports to the bladder, colon, and uterus including the small intestine. The weakened muscles cause the small intestine to decline all the way to the lower pelvic cavity and into the vagina, creating a vaginal hernia.
Rectocele
A rectocele condition is cause by the weakening of the pelvic support structures of the recto-vaginal septum. The condition is a result of difficult pregnancy and childbirth, chronic constipation, or hysterectomy. The thinning rectal wall may balloon out into the vagina when push down during bowel movement. Most rectocele conditions occur in the front wall of the rectum that is against the back wall of the vagina.
Uterine prolapse
Uterine prolapse is the descent of the uterus from its normal position in the pelvis to the outside of the vagina due to weak pelvic floor muscles. The condition is a result of aging and menopause, childbirth, chronic coughing, constipation, fibroid or tumors, and obesity including heavy lifting. Women who are involved in manual labor have a greater risk of developing uterine prolapse.
How to Insert a Pessary
Sometimes, doctors may ask the patients to care for the pessary themselves. To care for a pessary, wash hands with soap and water before taking out the pessary from its wrapper. Lie on your back and bend knees a little forward. Insert the pessary deeply into the vagina, tapered end first, using a finger or an applicator. Wait for 15 minutes before standing up. If process is dry and difficult, moisten the pessary with water, and then wash hands with soap and water.
All patients wearing pessaries should undergo regular gynecology examination for vaginal erosion or ulcers.
Wall (2003) cited that the use of vaginal pessary dates back to as early as the 19th century. Today, due to the modern gynecologic treatments, the need for the use of pessary in the management of vaginouterine disorders is limited.
Nevertheless, pessaries are here to stay for patients who do not desire surgery, for the elderly population and for pregnant women.
Source:
"Vaginal Pessaries," Pelvic Floor Dysfunction by G. Willy Davila, Gamal M. Ghoniem, Steve D. Wexner
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