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Pessaries and Your Pelvic Floor

January 20, 2017 | Dr. Janelle Morgan Evans, MS, MD, FACOG

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Surgery isn’t for everyone. For those who seek alternate solutions, the good news is that many pelvic floor issues have a conservative therapy solution that avoids the operating room.

With pelvic organ prolapse, or the falling of pelvic organs such as the bladder, rectum, or uterus (and often all three), there are plenty of options. While these are not intended to completely fix the issue, they can increase everyday comfort for you and also prolong the time until surgery is needed since prolapse does not always occur at a convenient time.

Pelvic Floor Therapy
Identifying and giving the pelvic floor muscles a workout with a trained pelvic floor therapist can help with symptomatic control of mild stages of prolapse. The therapist will work with you for 6-8 weeks generally and will teach special exercises to strengthen the muscles and reflexes.

Weight Loss
Weight loss is often recommended for many pelvic floor disorders, including prolapse and urinary incontinence. Most insurance will cover a limited amount of dietary advice and planning to help patients meet their goals.

Sometimes, however, the prolapse is beyond a point where the above options are not very helpful. In the case where a woman has significant prolapse and distress from it, but is not ready for a surgical correction, a pessary can be used.

A pessary is a typically silicon device that fits into the vagina and holds the prolapsing organ high enough so the pressure and bulge are more tolerable. Pessaries come in a wide variety of shapes and sizes, so in most cases, you can be fitted with one that causes no pain and is easy to maintain.

The two most popular types are the ring pessary and the gelhorn pessary.

The ring looks like an old contraceptive diaphragm, but with two holes in it for easy removal by the patient or physician. This pessary also allows the patient to maintain normal sexual function.

The gelhorn pessary looks like a baby pacifier. The knob portion is designed to more securely hold it in place by putting pressure on the back of the pubic bone. While a gelhorn is easy for a physician to place and remove, it is more difficult for the patient to do on her own.

The most important factor in finding the right pessary is that it should not be painful, and should not shift or pop out with straining, squatting, or any other normal life maneuvers. Most patients with a well-fitted pessary never think about it until they have to go back for checkups a few times a year.

Prolapse is not a dangerous condition most of the time, but it can impact lifestyle, so be sure to discuss all of your options with your provider. It’s important that you’re comfortable with the route you choose!

Find more articles on Prolapse, Prolapsed Bladder, Uterine/Vaginal Prolapse