Pelvic Organ Prolapse - Seek Wellness

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Pelvic Organ Prolapse - Seek Wellness

Page 1 of 3To access this or many other helpful articles, visit http://www.seekwellness.com/incontinence/tip-sheets.htmPelvic Organ ProlapseAs women age, their pelvic organs—the bladder, uterus, and rectum—may drop down, sag, or bulge(sometimes called “herniation”) into the vagina. Women may feel a “ball” or bulge coming out of the vagina. Thisis called “prolapse” or pelvic organ prolapse (POP).The different types of POP includeCystocele—dropped bladderUterine prolapse—dropped uterusRectocele—rectum bulges into the vaginaVaginal vault prolapse—all the pelvic organs push the walls of thevagina outThe amount of POP depends on how far the organ(s) have fallen or dropped out of the vagina. Usually it is“staged” which tells you how far it has dropped (Stage 1 is halfway down the vagina; Stage 4 is hanging out ofthe vagina). POP can be caused by childbirth, hormone changes, being overweight, constipation, or heavy lifting.It is also simply a part of growing older. Women with POP may have bladder urgency, may leak urine, andmay have to void more often.How Is It Treated?There is surgery where “mesh” material is inserted under the dropped organ to lift and support it. This is majorsurgery and it should only be done by an expert surgeon (a urologist who specializes in female pelvic and bladderproblems or a urogynecologist). But the first treatment offered is usually a device called a “pessary.” It hasbeen found that, by placing a pessary into the vagina, these symptoms can sometimes be relieved. Pessary useis considered a conservative type of medical treatment and does not rule out other interventions for prolapse orincontinence, such as surgery.What Is a Pessary?A pessary is a medical device that is put in the vagina to lift or support thepelvic organs. A pessary is made of silicone, or some older ones are madefrom latex rubber. All are flexible—they fold and bend. They are prescribedby a doctor or nurse practitioner. Some can be worn for a few days, whileothers must be removed at bedtime and inserted again the following morning.It takes time to fit a pessary. The first pessary you try may be perfect,but sometimes you must try a few different styles to solve your problem. It iscommon for the pessary to be resized soon after the first fitting.What Does a Pessary Look Like?Pessaries come in many sizes and shapes, but are most often round. Others look like a cube or a mushroom orare U-shaped. The ring pessary pictured above is often used. It is a “folding pessary” because it folds to insertand springs open once in the vagina. Inside the vagina, it rests against the cervix, similar to a diaphragm usedin birth control. Some other pessaries are pictured below.This information was provided by SeekWellness LLC© 2010 Diane K. NewmanPatient Education


Page 2 of 3To access this or many other helpful articles, visit http://www.seekwellness.com/incontinence/tip-sheets.htmPelvic Organ Prolapse (continued)The Gellhorn pessary is used for a large prolapse. You musthave some pelvic floor muscle strength so it stays in. It must beremoved for sex.The Gehrung pessary has an arch-like moldable “U” shape. It provides broadsupport under the bladder and prevents the uterus from falling.The cube pessary resembles a cube with six indentations thatproduce a vacuum or suction that holds it to the vaginal tissue.This helps the pessary stay in place.Other Support DevicesNew support pessaries, called “incontinence pessaries,” havebeen designed for use by women with mild urine leakage orstress incontinence caused by effort or exercise (like running).These pessaries provide support for the prolapse where thebladder neck (base of the bladder) joins the urethra, to preventurine leakageThis information was provided by SeekWellness LLC© 2010 Diane K. NewmanPatient Education


Page 3 of 3To access this or many other helpful articles, visit http://www.seekwellness.com/incontinence/tip-sheets.htmPelvic Organ Prolapse (Continued)A “tampon” is sometimes used as a very simple type of pessary. However, it is not what this product is made to do. Becausetampons are absorbent, a water-based lubricant such as K-Y Jelly should be used to prevent the cotton fibers fromsticking to the vaginal tissue. Tampons may be worn for only short periods of time.Can a Pessary Hurt Me?You should not be able to feel the pessary when it is placed inside you. It should be fitted for comfort and support. Somepessaries need to be removed each night, and your doctor or nurse will tell you. Most women also remove the pessaryduring sex. You should remove it weekly to clean it. You must have regular follow-up visits to have it removed and cleanedand to have a pelvic exam. These visits should be made at least every 6 weeks, and no more than 2 months apart. Appointmentsand checkups must not be missed. Changes in your ability to void or have a bowel movement, pelvic pain, orvaginal discharge should be reported to your nurse or doctor at once.Contact your doctor or nurse if you have:Foul-smelling discharge or itching in your vaginaTrouble voiding, emptying your bladder, or moving your bowelsBack pain, vaginal pain or burning, and rectal painWill I Need to Douche When I Use a Pessary?No, but if you have a discharge, a vinegar-and-water douche might be used so that the pessary will be more comfortableand less irritating. Trimo-San, a cleansing vaginal jelly, may be helpful. You insert 1⁄2 applicator-full of the jelly 3 times duringthe first week, then 1⁄2 applicator-full 2 times a week for as long as the pessary is worn. You may also need to use atopical estrogen product, such as a cream, to keep your vagina healthy.How Do I Put In, Remove, and Care for My Pessary?Your doctor or nurse practitioner will show you how to put in and take out your pessary. If you have ever used a diaphragmfor birth control, then you know how. Your husband or partner can also be taught. These are the steps:1. Empty your bladder before putting in or removing your pessary.2. When putting in your pessary, put water-soluble, lubricating jelly on the tip of the pessary, the part that will enterthe vagina first. Then hold the pessary with one hand and open your vagina with your other hand. Firmly push thepessary up and into your vagina. The pessary must be pushed to the back of the vagina so that it is under the cervixand behind your pubic bone. When it is properly placed, it should NOT be painful or uncomfortable.3. Find the position that is easiest for removing it. Usually women lie down with legs separated and knees bent, squaton a toilet, or lift and support one leg on a chair, a stool, or the toilet. When removing your pessary, put two fingersin your vagina and grab the pessary, then slowly turn it as you pull it down. Try to fold the pessary and carefullytake it out.4. Wash the pessary with warm soap and water. Then dry it.This information was provided by SeekWellness LLC© 2010 Diane K. Newman

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