Pessary

• Cystocele – Bladder drops from its normal place creating a bulge in the vagina
• Uterine Prolapse – Uterus has fallen out of place and down into the vagina
• Rectocele – Rectum drops from its normal place creating bulges into or out of the vagina
• Vaginal vault prolapse with enterocele – Vagina and small intestine drop from their normal place creating bulges in the vagina.

If you choose a pessary for treatment of your support problem your provider will try different pessaries until you get a good fit.

The pessary is the right fit if:

• It does not feel uncomfortable
• You bear down and it does not fall out
• You have no difficulty going to the bathroom

Some pessaries may be removed and reinserted at home. Those patients who are interested in learning how to remove and reinsert the pessary themselves will be instructed how to do this.

Some women, who have gone through menopause, may use vaginal estrogen to prevent injury to the vaginal tissue. The estrogen cream makes the lining of the vagina thicker and healthier. Your provider will order the vaginal estrogen if needed.

• You will be taught how to insert and remove your pessary. Pessaries vary in size and shape and the instruction will depend on your particular type of pessary. Many women with ring pessaries choose to learn how to remove and reinsert. The following instructions refer to this pessary.
• Wash your hands and the pessary with soap and water. Rinse and dry thoroughly. Fold the pessary in half. It will only fold one way (at the indentation areas within the ring.) If you are right handed and choose to insert the pessary standing up, place your left foot up on a chair, low stool, or toilet. Lean over this leg. Insert the folded pessary into the vagina (long ways) as far back as you can. It will open up into its normal shape when you let go on the ring. Use your index finger to make sure the rim is behind the pubic bone. If you are left handed, place your right foot up on a chair, low stool, or toilet. Use your left hand to manage the insertion of the pessary as stated above.
• Some women prefer to insert the pessary lying down. If so, lay down in bed. Bend your knees. Hold pessary as stated above and insert. You may also choose to insert the pessary by sitting at the edge of a chair.

• Use the same position as with the insertion.
• Insert index finger into the vagina and find the rim of the pessary.
• Hook finger under rim.
• Pull down and out.
• The ring will not fold up completely as with insertion, but the vaginal walls will stretch to allow removal.

• If you are able to care for your pessary at home, we typically recommend that you take it out and clean it daily. You should use a mild soap with water, rinse and dry it completely, and reinsert it into the vagina the next morning. It is OK to keep it in for a longer period of time but never more than 3 months at a time.
• If you care for your own pessary, we will usually have you come to the office for an examination initially in 2 weeks, and then in 3 months. After one year of use, you can come and see us 2 to 3 times a year. Most pessaries last for several years.
• It is not uncommon for the pessary to fall out when you are having a bowel movement. Check the toilet before you flush. It the pessary does fall into the commode, clean it with soap and water, and soak it for 20 minutes in rubbing alcohol. After this, soak it for 20 minutes in water, and wash again with soap and water. Rinse well. You may then insert it in the vagina.
• If you are unable to remove and reinsert your own pessary, we will want to see you in the office for cleaning and examination every three months.

• Vaginal bleeding
• Foul smelling vaginal discharge
• Pelvic pain or pressure
• Difficulty going to the bathroom or unable to go at all
• Vaginal irritation or itching sensation in the vaginal area
• Pessary falls out
• Unusual swelling or tenderness, fever, pains, or cramps in the lower abdomen