Devices

Treatment for genital prolapse

Vaginal prolapse can be treated with surgery or a vaginal pessary, a device that is fitted into the vagina. Newer techniques have improved the outcome for women with these problems. Some of these techniques are performed with less invasive approaches, and have proved to be quite successful.

Non-surgical treatment options

Pessaries
Pessaries are devices placed in the vagina to support the vaginal wall and lift up a prolapse. There are a variety of types of these devices, and we will properly fit you and teach you how to remove, clean and replace it yourself. Depending on the case, a pessary can be a temporary treatment for prolapse or it can be used for many years if the patient desires.

Use and Care of Pessaries

What is a pessary?
A pessary is a vaginal device that relieves the stress of a cystocele, a rectocele, a uterine or bladder prolapse, or the problems associated with urinary incontinence.

Pessaries come in a variety of shapes, sizes and materials. You should follow our advice about the use and care of your pessary.

Will I always have to use this pessary?
Not necessarily. Although pessaries are an alternative to surgery, your vaginal muscles may strengthen to the extent that your pesssary is no longer required. Sometimes pessaries are only required during exercise. Certainly, if you desire surgery, your pessary may only be temporary until corrective surgery can be performed.

Can a pessary hurt or become uncomfortable?
A properly fitted pessary should not cause pain or discomfort. You should be able to perform your normal daily activities without any difficulty. If the pessary is causing pain, you should call the office and schedule an appointment.

How often should I remove my pessary?
Ideally, a pessary should be removed 2-3 times a week and washed with mild soap and water. Many patients, however, are unable to remove it themselves. For these patients, we recommend an office visit every 6-8 weeks for a pessary check and cleaning.

What is my responsibility?
Your responsibility is to follow our instructions regarding the pessary, and keep all follow-up appointments. If you should move, be sure to notify your healthcare provider.

Why is the estrogen cream important?
The estrogen cream thickens the vaginal tissue and increases the blood supply to the tissue. This helps to prevent ulcerations, or breakdown of the vaginal skin, which sometimes occurs with pessary use. Women who use the estrogen cream will also have less vaginal and urinary infections. Some women who take estrogen by patch or pill and wear a pessary may still require estrogen cream in the vagina depending on the condition of the vaginal skin. We will discuss this with you at the time of your evaluation.

How should I use the estrogen cream?
The estrogen cream is usually only necessary two times a week. You should fill the applicator with the cream. We will discuss the necessary amount with you at the time of your office visit. Some women require ¼ of the applicator filled, while others need ½ an applicator of the medicine. The applicator should then be inserted into the vagina as high as possible and then depress the plunger. Once completed, you can remove the applicator and wash it with soap and water. Leave it in a clean, dry location until the next use.

Can I have sex with my pessary in place?
With most types of pessaries, you certainly can. You should remove the pessary following sex and clean it. If sex is uncomfortable with the pessary, you may remove it beforehand.

Will my pessary prevent a pregnancy?
No, it will not. A pessary is not a contraceptive device. If you are sexually active, wear a pessary and want to avoid pregnancy, we will recommend the most appropriate birth control method.

Can my pessary fall out?
Yes, it can. If your pessary is too small, it may fall out, especially with physical activity or a bowel movement. If this happens, you may clean your pessary with a mild soap and water and then reinsert it. If this is a persistent problem, call our office for an appointment. You may need a different size or type. If your pessary falls out due to straining to pass bowel movements, you may require a stool softener.

What should I do if I can not remove the pessary?
Do not worry if you are unable to remove your pessary. Stay calm, relax the pelvic floor muscles, and try again. If you are still unable to remove it, call the office and schedule an appointment.

What should I do if the pessary has moved out of position and has become uncomfortable?
Wash your hands. Lie down and push the pessary up as far as you can. If it remains uncomfortable, call the office and schedule an appointment.

What should I do if I see some discharge and bleeding?
Sometimes pessaries can irritate body tissues and cause bleeding or infection. This tends to occur if the pessary is not changed and cleaned regularly. Please call us to schedule an appointment if this occurs.

Can I take a bath, shower, or swim?
You may do these all of these activities as you normally would.

Should I douche?
You should not douche unless we instruct you to do so.

Colpexin Device

The colpexin device is a newer device also placed in to support the vaginal wall and lift up a prolapse. This device looks like a ping pong ball, and is placed in the vagina similarly to a tampon. The colpexin device requires contraction of your pelvic floor muscles to hold the device in place. Therefore, it not only reduces a prolapse, but it facilitates strengthening of your pelvic muscles. This in turn, may improve bowel, bladder and sexual function. This device may also be helpful in post surgical patients who require pelvic muscle strengthening.

Pelvic floor muscle exercises.

In addition to treating urinary incontinence, pelvic floor muscle exercises, or Kegel exercises, may help prevent progression of vaginal prolapse. These exercises are also useful following surgical correction of prolapse to help prevent a recurrence of the problem.

Avoid constipation by adding high-fiber foods to your diet. Stool softeners might also be useful, and we can discuss appropriate ones with you. Constipation, which causes chronic straining and pushing, can worsen prolapse and weaken the pelvic floor muscles.

Add 1-2 tablespoons of unprocessed wheat bran to your diet every day. Increase the bran gradually over several weeks until your bowel movements are regulated. Some patients require 6 tablespoons every day. The bran may be mixed into cereals, applesauce, gravies or pudding or sprinkled onto ice cream, fruit, or cottage cheese in order to make it easier to consume. If diet alone is not effective, fiber-based stool softeners and glycerin suppositories are safe and effective medications that can be used on a daily basis. Milk of Magnesia may also be used.

Some patients do not respond to any of these modalities, and they may require a prescription medication to relieve constipation. A colonoscopy or additional testing may also be necessary to evaluate the cause of the constipation.

Treatment for difficulty with bladder emptying

Since there are a variety of causes for this problem, several treatment options exist. Sometimes a cure can be expected, but for other patients, like those with neurological damage to the bladder, self catheterization may be the only reasonable treatment modality.

Intermittent-self catheterization

Although many patients are uncomfortable with the idea of catheterizing themselves, this may be the only effective treatment option for some. With time, may patients become comfortable and feel their quality of life improves. In addition, self-catheterization will decrease the chance of kidney damage that often occurs in patients that have a long-term inability to empty their bladders completely. Furthermore, studies have shown that with proper technique, the risk of infection is minimal.

Instructions on Self-Catheterization:

• Wash your hands and genitals using warm soap and water.
• Lubricate the tip of the catheter with a water-soluble lubricating jelly (not petroleum jelly)
• Spread the labia and insert the catheter. Use a mirror if necessary to locate the urethra.
• Keep inserting the catheter until urine starts flowing.
• Remove the catheter when urine stops flowing.
• Wash the catheter with soap and water, rinse well, and let air-dry. Store it in a clean, dry container.
• Hints:
• Tense muscles make it more difficult to insert the catheter. Try to relax.
• If you are unable to get any urine out, you are likely inserting the catheter into the vagina. First spreading the labia and then use a mirror and your index finger to locate the small urethral opening above the vagina.
• When first starting, try to catheterize yourself standing in the bathtub so you can concentrate on inserting the catheter and not worry about dirtying the toilet or floor.

• Too much lubricant may block the holes of the catheter and make it difficult for the urine to pass through. Too little lubricant may make it uncomfortable to insert.