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Pessary Insertion and Removal articles


The pessary is a device that is placed into the vagina to support the uterus and/or bladder and rectum. While there are many types and shapes, the most commonly used pessary is a firm ring that presses against the wall of the vagina and urethra to help decrease leakage and support a prolapsed vagina or uterus. The type and size of the pessary should be fitted to meet the needs of your problem and the requirements of your anatomy. A properly fitted pessary is not noticeable when it is in place.

Pesssaries Pessary

If you have sensations of pressure or rubbing with continued wear of the pessary, or if you notice any unusual vaginal bleeding or spotting, call your health care provider immediately. It is not unusual to have to change the shape or size of the pessary after the initial fitting or even after continued wear. This is why it is important to keep the your regularly scheduled clinic appointments.

You may be aware of 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. It can be kept in place for up to a week. The UCSF Women's Continence Center recommends only external cleansing. Do not douche or use vaginal products unless specifically provided by your health care provider.

Caring for a pessary is a skill easily learned. Pessaries can be left in place for up to a week, and removed for periodic easy cleansing. Some women choose to remove the pessary nightly before bed and replace it in the morning. It can be left in during intercourse if this is comfortable for you.

Inserting The Pessary

Wash your hands.

The notches inside the open ring and the openings in the ring-with-support are the flexible points. Grasp the device midway between these points and fold the pessary in half. The curved part should be facing the ceiling (like a taco). Put a small amount of water soluble lubricant (KY Jelly or other brand) on the insertion edge. Hold the folded pessary in one hand and spread the lips of your vagina with the other hand. Gently push the pessary as far back into the vagina as it will go. You can do this squatting, standing with one foot propped on the tub or toilet, or sitting with your feet propped up.

Postions for Insertion or Removal of Pessary

 

Insertion of the Pessary

 

Removing The Pessary

Wash your hands.

Find the rim of the pessary just under the pubic bone at the front of your vagina. Locate the notch or opening and hook your finger under or over the rim. Tilt the pessary slightly, about a 30" angle, and gently pull down and out of the vagina. If you can fold the pessary somewhat, it will ease the removal. Bearing down as if you are having a bowel movement can help push the rim of the pessary forward so you can grasp it more easily.

Removing the Pessary

 






Treatment- How to Insert and Remove a Pessary

Pessaries are used as a nonsurgical approach to the treatment of pelvic organ prolapse. They are frequently used to treat uterine prolapse in young women during pregnancy. In this instance, the pessary holds the uterus in the correct position before it enlarges and becomes trapped in the vaginal canal.

Pessaries are also used when symptoms of pelvic organ prolapse are mild or when childbearing is not complete. They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous.

Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a "pessary test." If you have a problem with incontinence with a pessary inserted, a separate surgery to fix the incontinence problem may be done at the same time as a prolapse surgery

How Well It Works

Pessaries do not cure pelvic organ prolapse but help to manage and slow the progression of prolapse by adding support to the vagina and increasing tightness of the tissues and muscles of the pelvis. Symptoms improve in many women who use a pessary, and for some women symptoms go away completely.

A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of pelvic organ prolapse.

There are a wide variety of pessaries now available, made of rubber, plastic, or silicone-based material. Among common types of pessaries are the doughnut, and the Gellhorn.

Your health professional will initially fit your pessary to hold the pelvic organs in position without causing discomfort. Pessaries come in a variety of sizes and should be fitted very carefully. See a picture of how a pessary should fit.

Pessaries can be used successfully to treat many other gynecologic conditions, such as a uterus that is in the wrong position.

Your inital pessary will be fitted in your health professional's office. You may need to experiment with a few different kinds of pessaries to find one that feels right and best for you. Your health professional will teach you how to remove, clean, and reinsert the pessary on a regular schedule. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary. If it is hard for you to remove and replace your pessary, you can have it done regularly at your doctor's office.

Pessaries are used as a nonsurgical approach, for treatment of pelvic organ prolapse. They are frequently used to treat uterine prolapse in women during pregnancy. In this instance, the pessary holds the uterus in the correct position before it enlarges and becomes trapped in the vaginal canal.

Pessaries are also used when symptoms of pelvic organ prolapse are mild or when childbearing is not complete. They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous.

Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a "pessary test." If you have a problem with incontinence with a pessary inserted, a separate surgery to fix the incontinence problem may be done at the same time as a prolapse surgery

Pessaries do not cure pelvic organ prolapse but help manage and slow the progression of prolapse by adding support to the vagina and increasing tightness of the tissues and muscles of the pelvis. Symptoms improve in many women who use a pessary, and for some women symptoms go away.

Risks

Possible complications from wearing a pessary include:

  • Open sores in the vaginal wall.
  • Bleeding.
  • Wearing away of the vaginal wall. In severe cases, an opening fistula can form between the vagina and the rectum.
  • Bulging of the rectum against the vaginal wall (rectocele formation).

Complications can be minimized by having a pessary that fits correctly and that does not put too much pressure on the wall of the vagina. Your pessary should be checked frequently by your health professional until both of you are satisfied with the fit.

In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.

Follow your health professional's instructions for cleaning your pessary, because regular cleaning reduces the risk of complications. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary.




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