History of Pessaries
Did you know the use of pessaries for pelvic organ prolapse dates back to the days of Hippocrates?! The use of pessaries was even documented in early Egyptian papyruses! Throughout the evolution of pessaries, many different materials have been used, ranging from pomegranates to linen to cork and even to brass. Read on to find out how pessaries are used today.
Today’s Pessary
Today, most pessaries available on the market are made of medical-grade silicone. This is the material of choice because it is non-porous, meaning that it doesn’t absorb odour nor does it trap bacteria that could lead to infections. Silicone is also durable so one pessary could last for years if cared for properly and it’s flexible, increasing insertion comfort. There are a few made of other materials; for example, the inflatoball is made of latex. If a woman has a silicone allergy, there are a few alternative options available from specific manufacturers- be sure to inform your physiotherapist of any known allergies.
When is a Pessary Useful?
Pessaries are used in the management of two pelvic health conditions: pelvic organ prolapse (POP) and stress urinary incontinence (SUI).
In POP, any or all of the pelvic organs (bladder, uterus, and rectum) hang lower than usual. The severity of how low they hang can range from just a little bit lower than normal to resting outside of the body. A pessary can be useful in this condition because it is temporarily inserted into the vagina like a tampon, giving support to the pelvic organs. This can greatly reduce the hallmark symptoms of POP including pressure, bulging, and heaviness in the pelvic area.
As for SUI, the classic symptom is leakage of urine with activity (coughing, laughing, sneezing, standing up from a seated position, running, jumping). SUI pessaries are designed to place a small amount of pressure on the urethra (the tube that drains the bladder), helping it to remain closed. This helps to reduce the likelihood of urinary leakage with activity, while still allowing the woman to void her bladder at will.
A pessary must be fitted for you by someone trained to do so (specialized doctors, nurses, or physiotherapists). There are many different shapes and sizes of pessaries. Your symptoms, activity level, stage of life and goals will be taken into account when choosing the most appropriate style of pessary for you. See our blog “Which Pessary is Right for Me?” for more information on this.
Women who choose to use a pessary may do so for several reasons. Sometimes they are used as an interim measure for women who are awaiting POP or SUI corrective surgery. This may be the case if there are long surgical wait times, or for women who wish to have more children before electing surgery. Some women choose not to have surgery at all and choose this as a permanent treatment option instead. Still others have been declined surgery due to other health concerns. And many women choose to use a pessary because they have bothersome symptoms that are not severe enough to warrant surgery. So as you can see, a pessary can be useful in many situations and women choose this treatment path for a wide variety of reasons.
When Can’t a Pessary be Used?
See our blog “Medical Conditions that may Prevent Pessary Use – Part I” https://torontopessaryclinic.com/medical-conditions-that-may-prevent-pessary-use-part-1/ and “Medical Conditions that may Prevent Pessary Use – Part II” https://torontopessaryclinic.com/medical-conditions-that-may-prevent-pessary-use-part-2/” for a discussion on medical conditions that may prevent a woman from using a pessary- at least until the medical condition has been adequately addressed and rectified.
Risks
One of the most common questions I am asked is, “Is a pessary safe for me to use?”. By and large, the answer is, “Yes!”. Pessary use is considered a conservative, low risk treatment option for POP and SUI. That said, there are a few inherent risks of pessary use. Read more on this in our blog “Potential Side Effects and Risks of Pessary Use”. https://torontopessaryclinic.com/potential-side-effects-and-risks-of-pessary-use/
Benefits
Pelvic organ prolapse is a condition that is treated based on a woman’s symptoms. Some women have a prolapse and don’t even know it- this is called an asymptomatic prolapse. Treatment is not necessarily needed in this case. Other women find their symptoms very bothersome and a nuisance to their activities of daily life. Pessary use has been reported to help up to 90% of women reduce their unwanted symptoms and improve life in the following ways:
- Decreased heaviness, pressure, bulging
- Decreased urinary leakage
- Improved bladder and bowel evacuation
- Improved sexual function
- Overall improved quality of life
Pessary use is a conservative, low-risk, under-utilized treatment option for two women’s pelvic health conditions: pelvic organ prolapse and stress urinary incontinence. Because of the low risk and potentially high benefit, it is worth looking into this option to see if it is right for you. Contact us today for an assessment and fitting!
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.
