Saturday, August 1, 2009

Pessaries- What are they and when do you use them?

Until surgical methods matured, Pessaries were the only form of treating pelvic organ prolapse (POP), such as cystocele, rectocele, uterine prolapse and stress incontinence. A pessary is classically a round ring that is placed into the vagina to reduce the prolapse. It derives from the Greek word pesos, meaning stone. Modern Pessaries can take many shapes: rings, cubes, horns, rings with knobs, and semi-circle forms. Since the lifetime risk for a woman in the US for undergoing POP surgery is 11%, pessary is often discussed as one of the non-invasive treatment options either for mild-moderate prolapse or in women who may not be good surgical candidates.

Pessaries must be properly fit to the woman’s pelvis and must be comfortable. Often, 2 or 3 fittings are necessary in order to see which size is appropriate. Not many practitioners are skilled in fitting Pessaries, but usually, a GYN nurse practitioner is the most common health care professional who does the fittings.

Care must taken when using a pessary. Women who have them inserted must be comfortable removing and placing them by themselves. They must be removed before intercourse. Local estrogen cream is necessary to keep the vaginal tissue from becoming irritated from the pessary. It can be left in during the day and removed at night. Side effects include: discharge, odor, vaginal skin irritation with bleeding, spontaneous expulsion, obstructive urination, and discomfort. Rare cases of vaginal erosion or ulceration can occur if women forget they have a pessary in place. If the woman cannot herself remove it, she must at least visit her practitioner on a frequent basis to have it removed and cleaned.

No comments: