Pessaries as a Treatment for Uterine Prolapse and Cerclage

What is a pessary, anyway?

A pessary is a soft plastic or silicon vaginal insert. It’s an effective tool for managing gynecological problems including stress urinary incontinence, cystocele, enterocele, rectocele, vaginal vault prolapse, or uterine prolapse and cerclage.

Many physicians are unfamiliar with pessaries, but they are essential tools. Pessaries are an indispensable stopgap until corrective surgery can take place, or as a replacement for surgery for the elderly or immunocompromised.



What is uterine prolapse?

Uterine prolapse is when the uterus droops or “falls out.” This issue can be rectified with either surgery or a pessary. Uterine prolapse can occur in women of any age, but several things can directly weaken the pelvic floor. Multiple vaginal deliveries, hysterectomy, chronic constipation or coughing, and repetitive heavy lifting can weaken muscles and lead to a variety of gynecologic issues.

Uterine prolapse happens when the pelvic floor muscles and ligaments stretch and weaken to the point where they can no longer support the uterus. Mild uterine prolapse doesn’t usually require treatment. It’s only when the lowering of the uterus becomes uncomfortable or interferes with daily life that patents usually seek treatment.



How to treat uterine prolapse

Treatment is unique for each patient. A doctor might recommend something as simple as self-care practices to stop the prolapse from worsening. These include Kegel exercises, weight loss, or preventing constipation. In more severe cases, a pessary can move things “back into place,” only requiring regular removal and cleaning. For some patients, surgery is a viable option.



What is a cerclage pessary?

A cerclage pessary is a cup-shaped silicone insert that supports a weakened or short cervix, while still allowing natural fluid drainage. Cerclage pessaries are suitable for many pregnant women whose cervix is at risk of opening before the baby is ready to be born or begins to open too early. The MedGyn cerclage pessary is available for international markets.



How to choose a pessary

Pessaries come in a variety of styles and sizes. After a complete pelvic exam, the patient will have a “fitting session” using simple ring pessaries. The largest pessary the patient can wear comfortably is usually the most effective. Once the size is determined, the patient is fitted with a pessary of the correct shape for her unique situation. The doctor may have the patient squat, sit, and move around to make sure the pessary is secure before she returns home.



Can a pessary “get lost”?

No, it can’t get lost, but it can fall out if the patient strains or lifts something too heavy. If this happens that means the pessary is too small and the patient should visit the doctor for a refitting.



Are there any issues with pessaries?

If there is any discomfort with the pessary or if the patient has trouble urinating or having a bowel movement, she should contact her doctor immediately. It’s possible that she needs to be refitted with a different size or style of pessary. Depending on the patient’s situation, chafing or odor may occur. These issues can often be addressed with over-the-counter remedies.



MedGyn offers around 20 pessary styles in all sizes. They are all made of soft, autoclavable silicon for easy care. We even offer a Pessary Remover to aid patients with their regular cleaning routines.