Pelvic Organ Prolapse and Fitting a Pessary

Pelvic Organ Prolapse and Getting Fitted for a Pessary

Sandy, a 56 year old woman, presented to my clinic with pelvic organ prolapse. This occurs when a pelvic organ, such as a woman’s bladder or uterus, drops from its original place and pushes against the walls of the vagina. There are different types and degrees of pelvic organ prolapse, bladder prolapse being the most common. Some women may not notice anything while other women may feel a bulge in their vagina or see the entire uterus protrude outside of the entrance to their vagina. A prolapse may impact emptying the bladder, can cause constipation, and/or can lead to pain during intercourse. In Sandy’s case, her prolapsed bladder was a grade III as it protruded outside of her vagina.

Sandy was quite distraught regarding her prolapse as it was having a big impact on her intimate relationship and her ability to work. She was a busy caterer and had a big event coming up, but was unable to sit at all and standing for any length of time was a challenge as well. Sandy was delighted to learn that she could be fitted for a pessary that same day.

A pessary, a small supportive device made from medical grade silicone, is an immediate conservative measure used to treat pelvic organ prolapse. There are many different models designed for the varying types and degrees of pelvic organ prolapse. Pessaries are also used for women experiencing stress urinary incontinence, which is a small amount of leakage with cough, sneeze, or exercise. In many cases, wearing a pessary allows women to avoid surgery and the associated risks such as urinary retention, bleeding and infection.

Within five minutes, I had performed an internal examination for Sandy, measured her vaginal vault and fit her with a size #4 Gehrung pessary to support her bladder and put it back in place. Pessary fitting is an art not a science and fitting 30 pessaries per week is not uncommon for me to fit.

The risk factors for pelvic organ prolapse are:

• Straining during vaginal birth
• Hysterectomy (surgical removal of uterus) as it leaves other organs with less support.
• Excess weight
• Chronic cough
• Constipation
• Pelvic organ tumors

In addition to the above, decreased estrogen receptors in the urogenital tract during peri-menopause (the years leading up to menopause) and menopause may lead to vaginal dryness and decreased elasticity in the vaginal walls. This may lead to pelvic organ prolapse. This is why it is so important that women address vaginal dryness often, which is often the first symptom of decreasing estrogen during those years. This can be done with personal moisturizers such as RepaGyn®, a hormone free ovule inserted into the vagina. RepaGyn® also has the added benefit of repairing vaginal tissues. Strong vaginal tissues are more supportive.

When a woman wears a pessary it is best for her to use a gel moisturizer or low dose localized estrogen in the form of a cream, tablet or a ring to keep the tissues healthy as these are known to be compatible with pessaries.

Sandy was thrilled with her pessary and her new found knowledge of her pelvic floor which she planned on sharing with her 30 year old pregnant daughter. You see, pelvic organ prolapse tends to run in families. Education is key for prevention.

With Sandy’s pessary and her healthier vaginal tissues she was delighted not only to get back the kitchen to fulfill her catering contracts, but she could also get back to the bedroom.