Effectively addressing pelvic organ prolapse (POP) is crucial for women's health worldwide. This condition impacts many women, and finding solutions that can alleviate symptoms and enhance their quality of life is of great importance. One popular solution is the use of pessaries, with the ring pessary being the most commonly prescribed option. In this article, we will delve into pessary use, discussing their benefits, risks, as well as the insertion and removal process.

Understanding Pelvic Organ Prolapse (POP)

Pelvic organ prolapse arises when the muscles and ligaments that normally support the pelvic organs weaken, leading to the descent of one or more pelvic organs (such as the uterus, rectum, or bladder) into the vaginal canal or protruding from the body. Various types of pelvic organ prolapse exist, including bladder prolapse (cystocele), rectocele, uterine prolapse, enterocele, and vaginal vault prolapse. Women experiencing POP often encounter symptoms like pressure, discomfort, pain, urinary incontinence, difficulties with bowel movements, and back pain. The impact on one's life can range from slight inconvenience to significantly affecting overall well-being. If you suspect you may have pelvic organ prolapse, it is crucial to consult a healthcare professional promptly to prevent the condition from worsening.

What is a Pessary?

The most commonly prescribed treatment method for POP is a pessary. Pessaries are prosthetic devices crafted from materials like medical-grade silicone, latex, or other biocompatible materials, which are inserted into the body through the vagina. These medical devices provide support to the prolapsed pelvic organ, helping it return to its correct position. This, in turn, alleviates discomfort and symptoms associated with organ prolapse (POP), allowing women to regain a sense of normalcy in their lives. Pessaries come in various shapes and sizes, and it is crucial to be properly fitted for a pessary that is suitable for your body and specific type of prolapse.

Ring Pessaries

One of the most commonly used pessary shapes is the ring pessary, named after its characteristic shape. Ring pessaries are appropriate for various types and degrees of organ prolapse, with suitability determined by factors such as the individual's age, overall health, the severity of the prolapse, and pelvic anatomy. However, women who have undergone a hysterectomy (removal of the uterus) may face challenges using a ring pessary, as the upper part of the vagina can become narrower after the surgery. Your healthcare provider will carefully select an appropriate pessary shape and size tailored to your body and specific needs. It is essential to ensure that the chosen pessary does not cause any discomfort or pain.

Insertion and Removal of Ring Pessaries:

Insertion:

Here is a brief overview of the steps involved in inserting a ring pessary by a healthcare professional:

1. Preparation: The ring pessary is folded into a figure-eight shape to reduce its width.
2. Lubrication: The pessary is lubricated for easy insertion.
3. Placement: The healthcare provider gently inserts the folded pessary into the vaginal canal. Once the pessary is halfway inserted, it is gradually released further into the vaginal canal.
4. Adjustment: The pessary is positioned to support prolapsed organs, ensuring comfort.
5. Verification: Correct placement is confirmed by asking the patient to cough and stand. Any questions or concerns from the patient are addressed at this point.

Removal:

Taking out a ring pessary is a process that can often be done by the patient themselves:

1. Positioning: The patient sits comfortably and relaxes their muscles.
2. Securing the Pessary: Using a finger, the patient hooks onto the ring pessary and begins to slide it out.
3. Sliding Out: The ring pessary is gently compressed and eased out of the vagina.
4. Cleaning: After removal, the pessary should be cleaned with mild soap and water, thoroughly dried, and then stored properly for reinsertion.

Frequency of Insertion and Follow-up Care:

The frequency of inserting a ring pessary and subsequent follow-up care depends on individual circumstances and healthcare provider recommendations. Typically, a follow-up appointment is scheduled approximately one week after insertion to assess patient comfort levels and evaluate the pessary's effectiveness.

Patients should plan to visit their doctor every 3-6 months to have the pessary changed. These regular appointments are crucial to maintain the pessary's efficacy and promptly address any potential issues. Living with a ring pessary involves a combination of adjustments, self-care, and regular communication with healthcare providers. By following the guidance of healthcare professionals and staying attuned to their bodies, women can effectively manage pelvic organ prolapse and lead fulfilling lives with pessary use.

Pros and Cons of Pessaries:

Advantages: Pessaries offer vital support for prolapsed organs, allowing women to regain comfort and control over their bodies. This non-surgical treatment option carries reduced risks compared to invasive procedures like surgery. Moreover, pessaries provide an alternative for women who prefer to avoid or delay surgery. They are also cost-effective, as most insurance plans cover their cost.

Drawbacks: While pessaries are generally well tolerated, some women may experience discomfort, pain, and other side effects, such as bleeding and increased vaginal discharge, which can lead to odor issues. Additionally, some women may struggle to keep pessaries in the correct position due to their pelvic floor anatomy. Women who choose a pessary as their treatment option should be diligent in attending doctor check-ups and maintaining their pessary to prevent potential risks and complications.

Living with a Pessary:

Adapting to life with a pessary involves making adjustments to ensure both comfort and effectiveness. While daily activities may require some modifications due to the presence of a pessary, the benefits it brings in managing organ prolapse can make these adjustments worthwhile.

• Physical Exercise: Engaging in physical activities is crucial for maintaining overall health, and having a pessary should not hinder this. Exercises such as walking, swimming, and cycling are generally well tolerated.
• Hygiene and Preventing Infections: Maintaining hygiene is of utmost importance when living with a pessary. It is recommended to regularly clean the pessary with gentle soap and warm water. It's important for women to thoroughly wash their hands before handling the pessary. Additionally, adhering to healthcare provider guidelines and avoiding scented products or douching is essential to prevent irritation and the risk of infection.

Long-Term Management:

Long-term management is crucial for the success of pessary use. Healthcare professionals will monitor the condition of the pessary to ensure it continues to provide adequate support. Any signs of complications, discomfort, or the need for replacement should not be ignored. In cases where prolapse worsens or if the pessary becomes ineffective, surgical intervention may be considered.

Other Treatment Options for Pelvic Organ Prolapse:

In addition to ring pessaries, there are alternative options for treating pelvic organ prolapse. Surgical procedures can involve repairing weakened muscles and ligaments or removing prolapsed organs. Making lifestyle changes such as maintaining a healthy weight, avoiding heavy lifting, and practicing pelvic floor exercises (Kegel exercises) can also contribute to managing and preventing prolapse. Some women might find support braces like FemiCushion helpful, as they offer external support to the pelvic region.

Conclusion:

Pessaries have proven to be an effective surgical alternative for managing pelvic organ prolapse. By carefully considering the advantages, drawbacks, and appropriate application methods, women can find relief and enhance their overall well-being. Collaborating closely with healthcare experts is essential to ensure that the pessary effectively offers the desired support. Treating pelvic organ prolapse with pessaries is a favorable treatment option for women who tolerate it well.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.