Do you sometimes accidentally leak urine when you laugh, cough, or sneeze? Or do you feel a heaviness, fullness, or a pulling sensation in your vagina? These are actually problems that many women experience, especially after having children, but are a little embarrassed to talk about. So today we are talking about a simple, non-surgical treatment for this. That is what a pessary is.
Simply put, what is a pessary?
A pessary is a small, removable device that is inserted into your vagina to support your pelvic organs. It is usually made of soft, non-toxic silicone.
Imagine, the organs in our pelvic cavity, such as the uterus, bladder, and rectum, are held in place by our pelvic floor muscles. It's as if these organs are being held in place by a net.
However, these muscles can weaken due to factors such as pregnancy, childbirth, weight lifting, and aging. Then, as if the mesh has loosened, the organs start to fall down or sag. We call this condition Pelvic Organ Prolapse (POP) , or "uterine prolapse." In such cases, this pessary is used to support those lowered organs and keep them up again.
In what situations is a pessary used?
A pessary is used as a treatment for two main conditions.
1. Pelvic Organ Prolapse (POP):
This is when an organ, such as the uterus or bladder, moves down the vagina. This can cause a feeling of fullness, heaviness, or something stuck in the vagina. In some severe cases, the organ can even protrude so far that it is visible through the vagina. A pessary helps to relieve this discomfort and provide support to the organ.
2. Stress Incontinence:
This is when a small amount of urine leaks out when there is a slight pressure on the abdomen, such as when laughing, coughing, sneezing, exercising, or lifting a heavy object. This is due to the weakening of the muscles that control urination. When a pessary is inserted, it provides a small amount of support to the urethra, so urine leakage can be controlled to a large extent.
Often, women who do not want to undergo surgery, or who are at risk of undergoing surgery due to other diseases, resort to this pessary treatment. Also, doctors recommend this as a next step when pelvic floor exercises have not yielded results.
What types of pessaries are there?
Pessaries come in a variety of shapes and sizes. Your doctor will choose the one that best suits your condition and body type. Let's take a look at some of the main types.
| Pessary Type | A simple description and use cases |
|---|---|
| Ring Pessary | This is like a round ring. This is the most commonly used type. It is very effective for stress incontinence and mild POP. It is easy to put on and take off. |
| Gellhorn Pessary | This is a disc-shaped device with a small protrusion in the middle. It is used in cases of advanced POP. In addition to providing support, it also fills the upper part of the vagina and prevents the penis from descending. |
| Donut Pessary | This is also round, but thicker than the Ring Pessary, resembling a doughnut. It is used as an alternative to the Gellhorn for severe POP conditions. |
| Cube Pessary | It looks like a square cube. But the sides are concave. It sticks to the vaginal walls (suction). This is also an option for severe POP conditions. |
| Other types | In addition to this, there are other types like Shaatz and Gehrung. The doctor will choose the most suitable type based on your condition. |
How to properly insert (fit) a pessary?
Inserting a pessary is not as difficult as you might think. This is done by your doctor. Let's take a step-by-step look at how to do it.
1. Pelvic Exam: First, the doctor will carefully examine your vagina and pelvic organs. The length, size, and degree of prolapse of your vagina will be taken into consideration to determine the appropriate pessary.
2. Choosing the type and size: Next, based on the test data, you will choose the type and size of pessary that best suits you. This is very important. If the pessary is too small, it may come off when you go to the toilet or strain loudly. If it is too large, it may feel uncomfortable and painful when it is inside. The right size is the size where you don't even know it is inside, but it doesn't come off either.
3. Inserting the pessary: The doctor will then carefully insert the pessary. You may use a lubricant to help it go in easily. If you are concerned about pain, a numbing medication may be applied to the vaginal opening. Talk to your doctor about any discomfort you may experience.
4. Checking if the pessary is in place: After the pessary is inserted, you will be asked to stand up, sit down, lean forward slightly, and cough to check if it is in place. You will also be asked to urinate before you leave. You should be able to urinate without any difficulty while the pessary is in place.
Remember, sometimes you won't find the perfect pessary the first time. It may take a few tries to find the right one. This is normal, so don't worry.
How do you care for a pessary and keep it clean?
The care of a pessary depends on the type. Some types, such as a ring pessary, can be removed, cleaned, and reinserted at home. Your doctor will show you how to do this.
- If you can clean it yourself:
- You can take it off and clean it once a week or maybe every night.
- First, wash your hands thoroughly with soap.
- Then take out the pessary.
- Wash with mild soap and water.
- Rinse thoroughly with water, dry completely, and reinsert.
- If it's a type you can't remove yourself:
- Some types, like Gellhorn, are difficult to remove on your own.
- At times like that, you should see your doctor every 3 or 6 months .
- The doctor will then remove the pessary, clean it, examine your vagina, and put it back in. This check-up is a must.
Benefits and potential challenges of a pessary
Like any treatment, a pessary has its benefits and some challenges. It's important to be aware of these.
| Benefits | Downsides / Challenges |
|---|---|
| The ability to control symptoms without undergoing surgery. | It may take several tries to find the right pessary. |
| It is very safe to use, and the risk is minimal. | Having to see the doctor frequently for maintenance. |
| The cost is very low compared to surgery. | Some breeds, such as Gellhorn and Cube, need to be spayed before having sex, and this may require the assistance of a doctor. |
| Providing quick relief from POP and Stress Incontinence symptoms. | In some severe cases, this may not be successful, and surgery may eventually be necessary. |
What are the symptoms to watch out for and when should you see a doctor?
Be aware of any changes in your body while using a pessary. It's normal to have a slightly increased vaginal discharge, usually white in color. However, if you notice any of these things, talk to your doctor right away.
- Pain or discomfort: If you feel pain or severe discomfort while the pessary is in place, it may not be the right size.
- Pink or blood-tinged discharge: This means the pessary is rubbing against the vaginal wall. You may need to switch to a different size or go without the pessary for a while.
- Unusual, foul-smelling vaginal discharge: This could be a sign of a vaginal infection. This may require antibiotics.
If you feel anything like this, don't make decisions alone, don't panic, and see your doctor right away. There are simple solutions to this.
Pessary or surgery? Which is better?
It's hard to give a short answer to this, because it varies from person to person.
In many cases, a pessary can help control symptoms and avoid surgery. However, if your POP is very severe, a pessary may not be effective. Some studies have shown that surgery can provide long-term relief for severe POP.
Also, for someone who is unable to visit the doctor regularly for pessary maintenance, surgery may be a better option.
Only you and your doctor can make the best decision about this. You should consider your situation, lifestyle, and preferences before choosing the best solution. So, don't be afraid or embarrassed to talk about this openly with your doctor.
Take-Home Message
- A pessary is a safe and effective non-surgical treatment for conditions such as prolapsed uterus (POP) and stress incontinence.
- This is not suitable for everyone. Your doctor will decide whether this is suitable for your condition.
- It's normal to have to try several times to find the pessary that fits you perfectly.
- Depending on the type of pessary, it is very important to clean it properly and see your doctor for a check-up at the scheduled time.
- In case of pain, abnormal discharge, or any other discomfort, do not self-medicate and seek medical advice immediately.
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