Pessaries: What They Are, Their Benefits, and Their Use
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The use of pessaries by middle-aged women has increased dramatically in the last few years. Pessaries are an effective tool for treating pelvic organ prolapse, a condition in which the pelvic organs, such as the bladder, uterus, and rectum, descend from their normal position. Pessaries are also used to treat urinary incontinence and vaginal vault prolapse.
This article will discuss what a pessary is, what they are used for, how they help alleviate specific symptoms, and the types of pessaries. This will give people insight into this valuable tool and how it aids women globally with various conditions.
The Prevalence of Women Using Pessaries
The prevalence of pessary use has increased over time. This may be due to increased awareness about the benefits of using this device and research on new pessaries that can be used to treat different conditions.
The number of people using pessaries varies significantly from country to country and from region to region. For example, in some countries, more than 50% of women over 80 years old wear pessaries, but in other countries, this number is closer to 20%.
Pelvic organ prolapse affects about 14% of women globally. It’s more common as women age, especially if they have had children. In a study conducted on women with organ prolapse, 40% also reported urinary incontinence, showing a need for this device throughout their daily lives.
Conditions that may be managed by a Pessary
Pessaries have been used in following conditions in aging women:
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Pelvic organ prolapse (the falling of pelvic organs)
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Urinary incontinence (leakage of urine)
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Cystocele (bulging of the bladder into the vagina)
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Rectocele (bulging of rectum into the back wall of the vagina)
A pessary may also be used to help patients prepare for surgery. Your doctor may recommend or prescribe pessaries for these conditions. In Canada, Pessary is classified as a Class 2 medical device and shall be used only when recommended by a healthcare professional.
The type of pessary you require will depend on your specific condition and needs. Your doctor will help you decide which type of device is best for you based on your diagnosis and symptoms.
Types of Pessaries
It is important to note that not all pessaries are created equal. There are different types of pessaries available on the market today, such as ring-shaped or flexible ones, which are inserted into the vagina like tampons, or a device called "The Keeper," which is inserted into the vagina and then removed at night when you sleep.
There are many different types of pessaries available on the market today. However, they can be divided into soft pessaries, hard pessaries, and vaginal cones.
Soft Pessaries
Soft pessaries are made of rubber or silicone and come in various shapes, cylindrical and cone-shaped. They are not as effective as hard pessaries because they can be displaced due to their soft material.
Hard Pessaries
Hard pessaries are made of plastic and have a concave shape that fits inside the vagina. They work well for women who have severe incontinence or prolapse.
Vaginal Cones
Finally, vaginal cones are made from either metal or plastic; they're shaped like cones with rounded tips so they can fit comfortably inside the vagina while still providing support where necessary.
Use of Pessaries
| Symptoms | Prolapse 1st Deg. | Prolapse 2nd Deg. | Prolapse 3rd Deg. | Cystocele | Rectocele | Incontinence |
Displaced (Retro) |
|
Pessary Type |
 |
 |
 |
 |
 |
 |
 |
| RING | X | X | X | ||||
| CUBE | X | X | X | X | |||
| GELLHORN | X | X | X | ||||
| SHORT-STEM GELLHORN | X | X | X | ||||
| DONUT | X | X | X | X | |||
| SHAATZ | X | X | X | ||||
| GEHRUNG | X | X | X | X | |||
| DISH | X | X | X | X | X | ||
| CUP | X | X | X | X | X | ||
| OVAL | X | X | X | ||||
| RING WITH KNOB | X | X | X | X | |||
| MARLAND | X | X | X | X | X | ||
| HODGE | X | X | X | X | X | ||
| INCONTINENCE RING | X | ||||||
| FLEXISHELF | X | X |
The Diagnosis Process
Before getting a pessary, you need to see your doctor, who will examine you and then recommend the type of pessary best for your condition. In most cases, this will require a visit to a gynecologist or a primary care physician, or even a urologist.
The diagnostic test for a condition such as pelvic organ prolapse (POP) is complex, and usually involves the following steps:
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Initial visit with a doctor (urologist or gynecologist)
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Examination of the abdomen
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Further testing based on findings
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Results are returned and patient is recommended/prescribed a pessary, or referred to a Pessary Clinic (for Pessary Fitting) or offered other appropriate remedies.
Follow-up with Healthcare provider at prescribed time intervals is very important to ensure that your symptoms are being properly managed by the device and whether the device is well tolerated. Any discomfort or Pain during use of Pessary shall be communicated with the Healthcare provider immediately.
Following resources were used in writing of this article:
https://www.healthline.com/health/pessary
https://www.verywellhealth.com/vaginal-pessary-4795713
https://my.clevelandclinic.org/health/drugs/16036-pessaries
https://www.medicalnewstoday.com/articles/pessary
https://urogynecology.nm.org/pessary.html
https://www.webmd.com/urinary-incontinence-oab/what-are-vaginal-pessaries