Pessaries are successfully used for the treatment of stress urinary incontinence and vaginal wall prolapse. These are plastic devices typically made of silicon, similar to vaginal contraceptive diaphragms, which are used to either liftand support the vaginal walls.
Success: About half of the women who are successfully fitted with a pessary will continue to use it on a long-term basis. Typical incontinence pessary users are women who
- Need temporary help with urine leakage 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 incontinence
Contraindications to using a pessary:
- vaginal scarring
- surgically narrowed or shortened vagina
- very weak pelvic floor muscles
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.
Because incontinence pessaries often apply some pressure on the urethra to prevent urine leakage, ideally a woman is taught to remove, clean and reinsert her pessary on a regular basis. 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 a vaginal skin erosion or ulceration.
Examples of Pessaries
