Pessary Use

So–this will tell you what I recommend for taking care of your pessary.   Look at all the types!!!

Your pessary has been put into your vagina to “hold things up”.  It should not be uncomfortable, and you really shouldn’t feel it during the day.

Now everybody is different when it comes to care—and the situation is different for each woman.

I have women who ONLY insert their pessary before they go to play tennis once a week, and others who have it in all the time.  Most women leave it in all the time.

Yes–you can get some discharge, and you may have some odor.   If there is odor, it is time to take it out and give it a wash, or use a Boric Acid suppository in the vagina.    If you are able to remove it, and insert it easily, then you could take it out at bedtime, and just wear it during the day.  You could take it out once a week,  once a month.   I wouldn’t go more than 6 months without having it removed–this is more for nursing home patients, or women who have arthritis or other reason they can’t remove it themselves, and need it removed by a doctor or nurse.

A nifty thing to use to keep things “fresh” down there is BORIC ACID CAPSULES.   NOOOO not the cockroach powder!!!   You have to get MEDICINAL BRAND.   You also buy some gelatin capsules (size OO), and you fill these up with the powder and put one INTO THE VAGINA once a week–twice a week if you have an odor.   It’s a bit like ‘Scrubbing Bubbles’—keeps things cleaner.  Typically you get 600 mg  into the OO size capsules.

In Canada, you can order your Boric Acid from Amazon!!!

Same in the USA!!  You can see if your local health store has some medicinal brand.  Oh,  and don’t worry about expiration dates.  This is a powder–it will last for years!!!

CLICK HERE FOR LINK TO BORIC ACID ON AMAZON–the capsules are there too!

When you are making it up–best use gloves–and don’t lick your fingers!!!  KEEP IT WELL AWAY FROM PETS AND KIDS!!!  You don’t want the dog, or cat, or your child around when making these up–it is poisonous (heavy metal), if you swallow it!  STORE IN A SAFE PLACE!!!!  MARK IT AS POISON–just in case you have a teenager doing what many do–swiping pills from your cupboard–hey—you never know!

SEE YOUR DOCTOR IF SOMETHING DOESN’T SEEM RIGHT!!

Now  –why do we use pessaries?

We use pessaries to treat PROLAPSE.  that means things are loose “down there” and “hanging a bit”–or a lot!

pessaryThe pessary slips into your vagina and rests on your pubic bone.  It seems like all the pictures on the internet show it quite far from the pubic bone—not accurate–so here is a picture I drew myself to show where it lies.

You see that the pessary holds up the bladder, and the uterus.  It does stretch the vagina a bit but your vagina is made up of folds–like an accordion.  These folds stretch around a baby’s head, and then come back–really –like an accordion.

I had a woman who came in over concerns about prolapse, and actually just had a looser “fold in the accordion”.  I explained that her uterus, bladder and bowel were still in good position, but that the folds of the vagina were “like an accordion”.  After the first baby they come back together almost all the way, after the second there is a little sag—and then more sag after each baby.

She says, “But it can still play!!”   Sure–beautiful music!!!

accordion1

BRAND NEW

 

 

 

 

 

 

 

 

accordion

accordion not quite back to tight after use!

 

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Your uterus and bladder can still be OK and you are just seeing more of the “folds”.   We don’t typically do anything about this, since it is not going to cause any physical problem.  You would have to let us know if you find this very distressing–but to remove the folds means surgery, and surgery means scar tissue—right in the spot that takes the brunt of intercourse (sex).   This scarring could lead to painful intercourse—so it’s often a matter of the “devil you know vs. the devil you don’t know”.  This is what is done with “vaginal rejuvenation” surgery—not without its risks!

You can have a dropped (prolapsed) bladder, bowel/rectum, uterus,  any combination of above, and even complete prolapse of vagina.

The bulges are seen by looking at the VAGINA.

http://petersphotogallery.com/vanea/images/2014/04/ProlapseTypes.jpg

http://images.slideplayer.com/23/6840302/slides/slide_23.jpg

If you have a drop or prolapse, you don’t HAVE to do anything, if it is not bothering you!  Many women have mild prolapses grade 1-2 after children, and it is not bothering them at all–so just carry on.

Some women ARE bothered by prolapse–they may feel things falling out when exercising–or they can’t ride their bike–or they find sex is interfered with.   These women may be offered a pessary, or surgery–or a pessary while waiting for surgery.  You can use a pessary for DECADES!!  Some women just use a pessary, and pop it out, and get it in with no difficulties.

Surgery for prolapse:

If you and your doctor decide that surgery is the option for you, then this surgery is typically done vaginally.  You end up with quite a few stitches inside the vagina:

here is a picture of what the inside of vagina looks like after a “bladder lift”

click here to see a rectocele

The metal tool is in the vagina holding up the bladder so you can see the BULGE is on the rectum side.

How does a pessary work?

https://secure.toolkitfiles.co.uk/clients/20292/siteimages/hires/Cystocoele_with_Ring_Pessa.jpg

It is placed into your vagina (they come in different sizes), and rest on the back side of your pubic bone and and the pelvic muscles to keep things from falling down.  There are many different types–as you can see in the picture above, but the RING pessary is the most commonly used.  We have the other types too–they each have a place.

Prolapse of the uterus may be helped with a ring pessary but sometimes a different pessary is needed–especially for grade 3 prolapse.  A Gellhorn is often used.

PICTURE OF GELLHORN PESSARY

 

This site–click here  has a lot of good information about prolapse!

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