A pessary is a plastic ring, similar to a vaginal contraceptive diaphragm, which is used to either lift the bladder or to apply some compression to the urethra during activities that are known to cause leakage. They are successfully used for the treatment of uterine prolapse. They are a low risk treatment option when compared to surgery for symptomatic prolapse and urinary incontinence. About half of the women who are successfully fitted with a pessary will continue to use it on a long-term basis. Typical pessary users are women who:
- Need temporary support during exercise
- Have mild symptoms and want to avoid surgery for the moment
- Have health problems that make the risks of surgery too great
- Need to delay surgery and are uncomfortable from their prolapse
There are numerous shapes and sizes of pessaries to meet the individual support requirements of different patients. Seeking care from a provider with a wide selection of pessaries may improve the chances of getting a comfortable fitting pessary. Not all women can have their prolapse successfully supported by a pessary. Situations such as scarring, a surgically narrowed or shortened vagina or very weak pelvic floor muscles can cause pessaries to fall out or be uncomfortable. Pessaries do require ongoing care to avoid problems with vaginal infection, ulceration or bleeding. A neglected pessary can result in erosions through the vaginal wall into the bladder or rectum.
In the ideal circumstance, a woman is taught how to remove, clean and reinsert her pessary at regular intervals. This can be as often as nightly or as infrequently as once per week depending upon the type of pessary and the overall health of the vaginal skin. Pessaries are not appropriate for women who cannot come for regular follow-up visits to the doctor¹s office. They should be avoided in women with dementia or those who have persistent vaginal erosions.
Frequently, vaginal estrogen cream, tablets or a ring are prescribed to women who use a pessary to strengthen the vaginal skin, especially for those in menopause. This will reduce the risk of developing any vaginal skin erosion or ulceration. If a woman cannot take care of her pessary, she will be advised to come to the office for removal, cleaning and vaginal exams every two to three months. If problems arise with infection or erosions, the visits may become more frequent.
The cost of a pessary is about $40 to $80 and this is not usually covered by insurance companies.