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How do vaginal support devices treat pelvic organ prolapse?

Vaginal mesh, a vaginal support device, is typically used for recurrent pelvic organ prolapse or more severe cases. Because it is a permanent material, when there are complications it can be difficult to correct them. It is like a knee replacement. Most people who see the orthopedic surgeon for knee pain have had physical therapy and their knee scoped once or twice before they move on to a knee replacement. Mesh is like a knee replacement.It works very well for most people, but when it doesn’t it can be very difficult to deal with.

A pessary, a type of vaginal support device, is a device that comes in multiple shapes that is placed in the vagina to hold the uterus up. In the past, pessaries were recommended for women who were felt to be a surgical risk. Pessary use is less frequent now since improved surgical techniques have made surgery a safer, more reasonable option for older and sicker patients. Some women with slight prolapse are only symptomatic when they are playing golf, or tennis, and find a pessary useful on an as-needed basis.

Vaginal support devices known as pessaries are sometimes used to treat severe pelvic organ prolapse where an organ is protruding into the vaginal canal. A pessary is a small, removable device that is inserted into the vagina to support the pelvic organ that is pressing through the vaginal wall. Pessaries come in a wide variety of shapes and sizes, and your doctor will work with you to find one that fits comfortably. Your doctor will show you how to insert and remove the pessary so you can take it out to clean it periodically. Keeping the pessary clean can help control the potential side effects of using a pessary, which include vaginal irritation and a foul-smelling discharge.

Dr. Kevin W. Windom, MD
OBGYN (Obstetrician & Gynecologist)

Vaginal support devices can help remedy problems with pelvic organ prolapse (POP).

A pessary is a small rubber device that comes in numerous shapes and sizes and it is placed into the vagina to help remedy POP. Some are made for cystoceles (bladder bulging into the vagina), some are made for rectoceles (the rectum bulging into the vagina), and some are made for uterine prolapse. It is important for patients to discuss alternatives to surgery when they are seeking medical attention for their POP. I often will talk to patients about the risks, the benefits, and the alternatives of surgical intervention, and will discuss the use of pessaries. It is important that a patient is able to place and remove the pessary on her own, otherwise the pessaries left in the vaginal area for long periods of time can cause erosions, ulcerations, and infections.

In my opinion vaginal mesh is the number one surgical treatment for pelvic organ prolapse (POP). Pelvic organ prolapse (POP) is when there is a tear in the connective tissue causing the bladder or bowel or intestines to protrude into the vagina. This, by definition, is a hernia in which these organs are prolapsing through a tear in the connective tissue. The best way to treat a hernia is by repairing the connective tissue. It is a very common practice for gynecologists throughout the United States to perform an anterior and/or posterior repair to remedy cystocele or rectocele respectively. This is a procedure where the connective tissue is "bustled up" to help with scaring and the hope is that this will keep the bladder or bowel from protruding into the vagina. This is a poor procedure because the patient has inherently weak connective tissue and, in my opinion, using the patient's own connective tissue to remedy their problem is wrought with failure. These surgeries carry a 35-45 percent failure rate. I believe that either biologic or polypropylene mesh is the best treatment for remedying pelvic organ prolapse (POP).

Dr. Jill Rabin
OBGYN (Obstetrician & Gynecologist)

Pelvic organ prolapse can be corrected by surgery. However, there are many mechanical devices available. A pessary may be inserted into the vagina to ensure support of the pelvic organs in cases of prolapse. Pessaries have been in existence since classical Greek and Roman times. Plastic material became available in the 1950s and today most pessaries are produced from sophisticated silicone and other materials. Today, pessaries are used mainly for problems of prolapse and incontinence when support is needed for weak tissues and organs. Over 20 different types of pessaries are in use today. They are available in a variety of shapes and sizes.

A pessary is a very personal item, and if you choose to use one, you must be evaluated by a medical practitioner and then fitted for it individually in order for it to do its job effectively.

The pessary works much like an internal girdle to support the bladder, vagina, uterus, and rectum. It is inserted into the vagina and it basically substitutes for the connective tissue and strong muscle that most of us were born with. It replaces the organs from a dropped or prolapsed position to a position higher in the abdominal cavity. It does this by pressing on the undersurface of the vaginal support muscle, known as the levator muscle. So it replaces the organs by pushing up into the abdominal cavity on the undersurface of the pelvic support muscle, the levator muscle.

It is very important to clean the pessary periodically. You can do this for yourself every week, or even more often. Remove it, clean it, clean the vagina, and replace the pessary.

Many women decide to use the pessary only for daytime use. Others see their practitioner, their gynecologist, or their family doctor every 2 to 3 months to have the pessary removed and cleaned. If that is performed, then the provider needs to also remember to do a vaginal cleaning or douche prior to replacing the pessary.

There are antibacterial gels available to use with the pessary to decrease bacterial content. It is also very important to make sure that any erosion or irritation of the vagina is treated by your provider. This can occur from an improper pessary fit, or leaving the pessary in too long. Other side effects can include back pain, vaginal odor, bleeding, pain, urinary or stool retention.

Pessaries must be properly fitted and cared for, which takes quite a bit of patience. If the pessary does not fit properly, over time it can be refit to a different type or size.

Vaginal support devices such as pessaries are an appropriate treatment for women who don't want surgery for pelvic organ prolapse but are bothered by the bulge. They're also appropriate for women who are not surgical candidates because of other medical co-morbidities, and for women who want to postpone surgery and obtain relief from their symptoms in the meantime.

A pessary is a device that you can put in the vagina. It looks like a diaphragm that is used for contraception. They are made of silicone and come in many different shapes and forms depending on the prolapse and the anatomy of the particular woman. They need to be fitted to work correctly.

In women that are well fit with a pessary, there’s some data to show that at one to two years, about 60 percent of them will describe being very satisfied with this therapy, and about 40 percent will want to continue this therapy in the long-term.

Not all women with pelvic organ prolapse can be treated with pessaries. Successful fitting of a pessary depends on the amount of prolapse, the length of the vagina and the width of the vagina. If the prolapse is too severe, it will push the pessary out. Prior vaginal surgery decreases the chance of somebody being well fitted for a pessary while the use of vaginal estrogen usually improves the chance of somebody tolerating a pessary well.

When using a vaginal support device, such as a pessary, for pelvic organ prolapse, the pessary will need to be removed every one to two months, cleaned and replaced. Many people are able to do this at home. However, some women will need to have a medical practitioner do this for them.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.