In some women the pessary works well with respect to holding their organs in place, but it “unmasks” incontinence. This means that when you use the pessary you start to leak urine. When that happens the choice is to not use the pessary, live with the prolapse and remain dry or have surgery.
You may notice an increase in vaginal discharge or secretions with pessary use. However, the pessary is made of silicon rubber and does not absorb odors or secretions. The Center for Urogynecology and Women's Pelvic Health recommends only external cleansing.
A pink or bloody discharge could mean the pessary is rubbing against the wall of the vagina. In most cases, removal will allow the area to heal. In cases of bleeding, a visit to a nurse or doctor is needed. White-colored discharge from the vagina is common with pessary use.
They are designed to support the urethra and bladder wall, increase urethral length, and provide gentle compression of the urethra against the pubic bone. This structural arrangement reduces and often prevents leakage when intra-abdominal pressure increases, essentially resolving the problem of incontinence.
If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you are not having contractions after 24 hours, you may be offered another dose. Sometimes a hormone drip is needed to speed up the labour.
Obesity, previous reconstructive pelvic surgery, and advanced symptomatic pelvic organ prolapse (POP) are the three significant risk factors for an unsuccessful pessary fitting, according to a systematic literature review and metanalysis in the journal Neurourology and Urodynamics.
A well fitting pessary will not cause pelvic discomfort when standing up and walking. When you cough, bend forwards, squat or hold your breath and strain the device should not move down out of your vagina. If the pessary moves to the entrance or out of your vagina you may require refitting with a larger size.
The Downside of a Pessary
“Occasionally, some women experience vaginal irritation from them.” Some also experience extra vaginal discharge, according to a January 2015 study in The American Journal of Obstetrics and Gynecology. Fit can also be a challenge.
Several studies have evaluated the success of pessary fitting, with success rates ranging from 41% to 74%. Success rates of up to 62% have been reported in patients with stage III and IV prolapse, indicating that pessaries are an excellent option even in a population with advanced POP.
Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium chloride.
Getting the most from your treatment
If your symptoms do not improve within seven days, see your doctor for further advice. A pessary will dissolve overnight in the moisture in the vagina. If you have problems with vaginal dryness you may notice some undissolved pieces of pessary the following morning.
When you choose a pessary for the right patient, evidence shows that about 75 percent of these patients will report improvement in their prolapse symptoms.
For some women, their prolapse gets worse over time. For others, their prolapse will stay the same with conservative treatment options. Prolapse generally does not improve without surgery, but symptoms can be managed with less invasive treatment options.
Since the pessary dissolves in the vagina, it may be helpful to wear a panty liner because it is quite common to notice a slight white residue (chalky) after using the pessary. This does not mean that the treatment has not worked. The symptoms of thrush should disappear within three days of treatment.
Place a small amount of water-soluble lubricant on the pessary edge only that will be inserted first into your vagina. Do not cover the whole pessary with lubricant because it will be difficult to hold. You can purchase the lubricant at most pharmacies. Some examples are K-Y Jelly® or Astroglide®.
In a prospective, self-controlled clinical trial published in Investigative and Clinical Urology in March 2022, Mayo Clinic investigators found that both pessary use and surgery for pelvic organ prolapse improved symptoms. However, patients deemed the degree of improvement more significant for surgery.
The average pessary size is 4 or 5, the range being from 2 to 7. The patient should then spend about an hour walking around and trying to void. When she returns, remove the fitting ring and select the appropriate pessary. Part of ring should settle behind the cervix and the opposite side behind the pubic notch.
6. If it does not feel comfortable, use your index finger to gently push it in a little farther. You can't hurt yourself or the pessary doing this. The rim of your pessary should sit just under the pubic bone at the front of your vagina.
In some women the pessary works well with respect to holding their organs in place, but it “unmasks” incontinence. This means that when you use the pessary you start to leak urine. When that happens the choice is to not use the pessary, live with the prolapse and remain dry or have surgery.
If you use too much
If you insert too many pessaries at the same time, you may feel discomfort or irritation. Stop using the pessaries and see a doctor if the discomfort or irritation does not go away.
Anterior prolapse (cystocele)
Anterior vaginal prolapse, also known as a cystocele (SIS-toe-seel) or a prolapsed bladder, is when the bladder drops from its usual position in the pelvis and pushes on the wall of the vagina.
Pelvic organ prolapse doesn't necessarily get worse over time, and you may not need treatment if the symptoms are not affecting your daily life. Nonsurgical treatments for pelvic organ prolapse can reduce the pain and pressure of mild-to-moderate prolapse and preserve fertility if the uterus is prolapsed.
If your prolapse is moderate to severe or symptomatic:
Balance your activities and exercises with good rest. Put your feet up if the opportunity arises during the day. Try to avoid prolonged standing or heavy/repetitive lifting.
Many women notice their symptoms being worse two days before their period and through their period. When you are aware of these possible fluctuations you can try to manage your prolapse more effectively at this time, by managing your activities of daily living.
Possible Aggravating Factors:
Slacking off with pelvic floor exercises (causing weakness) Overdoing pelvic floor exercises (causing fatigue and tightness) Constipation and straining. Change or increase in higher impact exercise including running or lifting heavier weights.