Chapter 39 Pessary Therapy
THE CHALLENGE
Scope of the Problem: As our population ages, the prevalence of pelvic relaxation disorders will increase. Pessary therapy offers an attractive, effective, nonsurgical therapy for many of these patients. Patients with symptomatic pelvic relaxation, uterine retroversion, cervical incompetence, or urinary incontinence may benefit from this form of therapy. It is estimated that 10% to 15% of women suffer from anterior vaginal wall support failure, and this increases to 30% to 40% after menopause.
TACTICS
Relevant Pathophysiology: Pessaries act either by using existing pelvic support mechanisms or by diffusing the forces acting on pelvic structures over a wide area so that support and reposition are achieved. Available in a variety of types and sizes, the most commonly used forms of pessaries for pelvic relaxation are the ring (or doughnut), the ball, and the cube. To varying degrees, the pessary occludes the vagina and holds the pelvic organs in a relatively normal position. The type of pessary chosen is based on the indications of the individual patient. Pessaries are available in both latex and polyurethane types. The latex type is often less expensive but tends to deteriorate over time; polyurethane pessaries are less likely to retain odor or cause irritation.
Strategies: Pessaries are fitted and placed in the vagina in much the same way as a contraceptive diaphragm (see Chapter 249
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