Vaginal Pessary: A Non-Surgical Treatment Option for Pelvic Organ Prolapse
A vaginal pessary is a medical device that is inserted into the vagina to support the pelvic organs. Pessaries come in various shapes and sizes to treat different pelvic floor disorders. They work by using leverage and gentle pressure to hold organs like the uterus, bladder, or rectum in their proper position.
Types of Vaginal Pessary
There are several common types of pessaries that are prescribed based on a woman's individual needs and symptoms:
Ring Pessary - This donut-shaped device is one of the most basic types. It is flexible and expands to a circle shape once inserted. Ring pessaries provide support evenly all around the vaginal walls.
Cube Pessary - Cubic or geometric pessaries have firm sides rather than a rounded shape. They offer strong, targeted support in certain areas like behind the pubic bone.
Gellhorn Pessary - Resembling a cylinder or cone shape, the Gellhorn pessary is tapered at one end for easier insertion. The other end has a wide base for superior pelvic organ support.
Doughnut Pessary - Very similar to a ring pessary but with a smaller inner diameter for more focused pressure. Doughnut pessaries are ideal for supporting lighter prolapsed organs.
Hodge Pessary - This pessary design features a spherical shape with an opening at the top for the cervix or vaginal apex. The Hodge provides three-dimensional, whole-pelvic support.
Measuring and Fitting Process
To determine the right Vaginal Pessary type and size, a medical provider will examine the vagina and palpate the pelvic floor muscles and organs. Gentle presses on the abdomen can replicate conditions like coughing or straining to observe potential prolapse or organ positions.
Digital assessment using gloved fingers provides critical measurements of the vaginal canal width, length, and texture. Special pessary fitting kits contain a wide selection of shapes and diameters to test for comfort, support, and whether the device stays in place without causing pain or pressure points.
The initial fitting may require adjustments over the first few weeks or months as the tissues adapt. Regular checkups every 6-12 months allow the provider to assess if a different pessary design or size is now needed based on any changes with menopause, weight fluctuations, or surgical interventions like hysterectomy.
Benefits of Pessary Therapy
When fitted properly, Vaginal Pessary can successfully treat many pelvic floor disorders:
- Cystocele - When the bladder bulges into the vagina. A pessary cushions the bladder in its correct anatomical position.
- Rectocele - Occurs when the rectum prolapses into the posterior vaginal wall. Appropriately sized pessaries elevate and support the rectum.
- Uterocele - The descent and protrusion of the uterus into the anterior vaginal wall. Pessaries prevent further dropping of the uterus.
- Vaginal Vault Prolapse - Following hysterectomy, the top of the vagina may slide downward. Pessaries maintain the vaginal apex in a high resting state.
- Stress Urinary Incontinence - Some pessary types can compress the urethra for urinary control when sneezing or coughing.
- Pelvic Organ Prolapse Symptom Relief - Heaviness, pressure, painful intercourse, urinary/bowel issues may all improve.
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