Uterine prolapse significantly reduces a woman's quality of life. Most often, prolapse of this organ occurs in adulthood and old age. Pathology is characterized by physical discomfort, problems with urination and defecation. Sexual intercourse with prolapse of the uterus is unlikely or not feasible at all. In order to return the woman the opportunity to fully live and work, partially solve the problems that appeared along with the weakening of the muscles and ligaments of the uterus, a gynecological pessary is used.
A gynecological ring is used in cases where surgery cannot be performed. When deciding to use a pessary, you need to remember that only an operation can completely rid a woman of pelvic organ prolapse.
What is a pessary?
A pessary, or gynecological ring, is a product made of elastic medical silicone or latex. This hypoallergenic, safe device is inserted by the doctor into the patient’s vagina, easily occupying the desired location without affecting the woman’s activity and lifestyle.
The main function of the gynecological ring is to create support for the organ, an obstacle to its displacement from the anatomically correct position. For each specific case of prolapse of the uterus, a certain type of pessary is selected, which differs from other rings in shape, size, diameter and type of purpose.
Urethral - has the shape of a ring with a thickening outward, is used to fix the uterus and urethra at the same time,
Cup, cup perforated - has the shape of a bowl with a large hole or with perforation, it is used at an average and initial level of uterine prolapse,
Cup-urethral - combines the qualities and advantages of both previous types,
Cubic, Cubic Perforated - has the shape of a cube with walls concave inward with an opening for excretion, is used for severe prolapse, is worn for a short time (8-12 hours),
Mushroom - has the shape of a ring with a leg, used for severe uterine prolapse, the pessary is removed at night,
Hodge pessary - used in special cases in women with anatomical features of the uterus and vagina, takes any form,
Thin and thick ring - used in the initial stage of prolapse.
Each pessary species has several sizes. If the size of the gynecological ring, which the woman needs, is calculated incorrectly, she will not be able to use the device. Therefore, the selection of a pessary should be entrusted to a doctor. So, for example, if, with a strong prolapse of the organ, a ring-type device is used, the risk of pushing the uterus through the ring and its infringement increases.
Video, including a description of the obstetric unloading pessary "Juno" and the methodology for its use:
Pros and cons of using gynecological pessaries
Uterine prolapse is partially compensated
You can do without surgery,
Pessaries are easy to use and care for,
Devices are safe and hypoallergenic,
With the right selection of the gynecological ring, there is no risk of injury to the soft tissues of the pelvic organs.
Disadvantages that prevent the use of the pessary for its intended purpose:
When wearing a gynecological ring, the volume of discharge from the cervical canal may increase,
It may be difficult to have sex,
The pessary cannot be used for inflammation of the pelvic organs, although wearing it is required, first of all, for women of mature age, whose atrophy mucosa is extremely susceptible to the action of bacteria,
The psychological barrier prevents the presence of a foreign object in the vagina.
How to use a pessary?
The doctor will help to install the device for the first time, having performed this procedure on an outpatient basis. He will certainly introduce the woman to the rules for using pessaries, teach her self-introduction. Before administration, the gynecological ring is sterilized or rinsed in boiling water. To facilitate administration, you can use petroleum jelly, vaginal cream, vegetable oil.
To return the uterus to its usual position, before the introduction of the pessary, you need to lie on your back. The compressed device is taken into the hand and inserted into the vagina until it contacts the cervix. Very strong pressure on the neck should be avoided. Then the woman can get up.
All types of pessaries except the cuboid and mushroom devices can be worn for up to 30-40 days without a break. After 10-14 days, a woman should get a doctor’s consultation to examine the vaginal mucosa and assess the appropriateness of using a pessary. A correctly installed device does not cause discomfort, does not shift when walking, defecating, and urinating.
Video about the introduction of the pessary:
Why is it necessary to use a pessary when lowering the uterus?
If you do not compensate for the prolapse of the uterus, the following complications may occur:
The development of colpitis, cervicitis, the penetration of infection into the uterus and ovaries due to gaping genital gap and low position of the cervix,
Leakage of urine during stress, laughter, weight lifting due to drooping of the front wall of the bladder,
The development of cystitis, pyelonephritis due to problems with urination,
The development of eczema and pyoderma due to skin irritation by urine,
Infringement of the uterus and the walls of the vagina in the genital gap, necrosis of organs due to circulatory disorders,
To prevent complications of uterine prolapse, a gynecological pessary should be worn.
Education: The diploma "Obstetrics and Gynecology" was obtained at the Russian State Medical University of the Federal Agency for Health and Social Development (2010). In 2013, graduate school at NIMU im. N.I. Pirogova.
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Uterine prolapse is the wrong position of the uterus, the displacement of its bottom, as well as the displacement of the cervix below the normal border due to the weakness of the muscle fibers of the pelvic floor and ligaments. Pathology is accompanied by a number of characteristic symptoms: a feeling of pressure, a feeling of discomfort, patients are concerned about pulling pains in the abdomen and vagina.
A famous gynecologist from the United States A. Kegel in the middle of the last century proposed a simulator for the effective recovery of perineal muscles in women with postpartum urinary incontinence. He saw the cause of this disorder in a weakened urethro-vaginal sphincter. Exercises called Kegel gymnastics are widespread.
In the treatment of the early stage of weakening of the muscles and ligaments that hold the uterus in the correct position, and for the prevention of this condition, gymnastic exercises are effective. In the lower part of the vagina are muscles that support the tone of its walls and the tone of the sphincter of the urethra. These muscles are of great importance.
Prolapse and prolapse of the uterus - what is it?
Uterine prolapse in women occurs due to the loss of pelvic and abdominal muscles of the usual firmness and elasticity. This is a serious illness, a symptom of which is the exit of the uterus from the vagina. The risk group in old age and the appearance of this pathology include women who previously had multiple or several normal pregnancies.
What is a pessary
A pessary is a hypoallergenic silicone device that is actively used in gynecological practice. This system allows you to prevent, as well as stop the development of certain diseases of the intimate sphere, including during pregnancy.
Manufacturers of uterine rings use environmentally friendly materials that are not harmful to the female body. The elasticity of the device allows its use at different stages of omission. After administration, the ring easily adjusts to the shape of the patient's genitals and does not cause discomfort. Like any technique for treating uterine prolapse, the pessary has its own advantages and disadvantages.
Advantages of the gynecological ring with prolapse of the uterus:
- returns the uterus to its normal anatomical location,
- allows you to do without surgery,
- effective in all forms and stages of prolapse,
- does not injure the genital mucosa,
- does not cause discomfort
- can be applied over time,
- has a different cost, suitable for any budget,
- suitable for repeated administration,
- Allowed for independent use.
Cons of the ring in the treatment of prolapse of the uterus:
- increases the risk of inflammatory processes,
- doesn’t solve the problem completely, because after removal the organs fall to their original position,
- excludes the possibility of intimacy,
- provokes an increase in vaginal discharge,
- creates psychological discomfort for a woman,
- requires constant care and treatment with antiseptics,
- forces the patient to regularly conduct vaginal debridement,
- during the first months of wearing obliges the patient to be examined by a gynecologist every 2 weeks.
The uterine ring is recommended for prophylactic use in women who have a risk of pelvic prolapse - perineal injuries, multiple births, and a genetic predisposition.
Be sure to assign a pessary to patients with such indications:
- prolapse of the uterus of the initial stage,
- absolute prolapse of the cavity of the genital organ,
- there is no possibility of surgical treatment,
- urinary leakage occurs.
The uterine ring for prolapse of the uterus is necessary for patients who have undergone surgical intervention. The device is needed in order to unload the muscles of the pelvic floor and accelerate recovery. The pessary is also recommended for women in preparation for surgery. The system allows you to temporarily alleviate the condition and eliminate pain.
How to install
Installation of the pessary in case of uterine prolapse is carried out in the office of a gynecologist. It is first necessary to exclude contraindications and conduct an examination:
- a vaginal swab for purity and latent infections,
- cytology to exclude atypical cells on the cervix,
- colposcopy to assess the condition of the neck,
- Ultrasound of the small pelvis to determine the position of internal organs.
Before you enter the pessary into the vagina, it is necessary to sterilize it. For this, hydrogen peroxide is usually used. The woman is located on the gynecological chair, and the gynecologist lubricates the ring with petroleum jelly to facilitate sliding along the mucosa. The device is inserted into the vagina, raising the lowered uterus and fixed on the neck.
The fact that the size and shape of the ring are selected correctly is indicated by the absence of discomfort in the patient. After the procedure, a woman can return to her usual affairs. While wearing a gynecological ring, sex, swimming in public water, the use of vaginal products and heavy physical exertion are not recommended.
And instructions for use
For proper use of the ring, you must study the instructions for use. The annotation details how to store and sterilize the pessary. For each system, the manufacturer gives individual recommendations in accordance with the form and material of manufacture. General recommendations:
- wear a strictly limited period of time by a doctor,
- remove for periodic cleansing,
- for sterilization use a solution of hydrogen peroxide concentration of 3%,
- keep the ring in peroxide for 3 hours.
Store at room temperature. Keep away from direct sunlight. In addition to following the instructions for use, it is necessary to adhere to the recommendations of the doctor.
How to use it correctly
During the installation of the ring, the gynecologist explains to the patient how to independently remove and install the system. Most support devices are unsuitable for continuous use and require periodic treatment with antiseptics.
To remove the ring, you must squat or raise one leg. With the thumb, forefinger and middle finger, the pessary is captured and slowly removed from the vagina. Usually this does not cause discomfort. After that, the ring is cleaned according to the instructions. The introduction of the ring is carried out in a prone position. Lubricate the device to facilitate gliding and prevent injury to the vaginal mucosa.
Depending on the stage of prolapse of the uterus, the gynecologist sets the period of time during which it is necessary to use the ring. It is advisable to use it during wakefulness and physical activity. Typically, women are prescribed to wear a pessary during the day, and in the evening to remove and at night be without it. The course of application of the device is also determined individually.
The doctor may prescribe a ring for 1-5 months or recommend lifelong use.
It should be remembered that all types of pessaries with prolapse of the uterus increase the risk of inflammatory processes in the vagina. Therefore, women are recommended periodic rehabilitation of the genital tract. To do this, use Miramistin solution or Hexicon candles. When infections occur and the intimate microflora changes, other drugs for local treatment can be prescribed - antibacterial, antiviral, antifungal.
Gynecological pessary is not recommended for use with:
- a high probability of developing allergic reactions to the material from which the device is made,
- cervical cancer or dysplasia,
- the formation of erosive and ulcerative lesions of the vaginal mucosa and neck,
- inflammation of the uterus with prolapse,
- acute infectious diseases of the genital organs or exacerbation of chronic,
- tumor processes in the abdominal cavity, pelvis or vagina,
- uterine bleeding of unknown origin,
- congenital malformation of the uterus or appendages,
- the unsuccessful result of using the pessary when dropping the uterus in the past.
If during the preliminary examination, infectious and inflammatory diseases of the vagina and cervix are detected, the patient is pre-prescribed treatment. After eliminating contraindications, it is permissible to use a vaginal ring to treat uterine prolapse.
The cost of the pessary depends on the manufacturer, the material of manufacture and form. Popular firms are Dr. Arabin and Juno. The cost of the ring starts from 300 rubles and reaches several thousand.
For installation in a private clinic, the patient will also have to pay from 500 to 3000 rubles.
It is necessary to choose a support system, paying attention to the stage of prolapse of the uterus, the age of the patient, the number of births in the anamnesis, as well as related symptoms. With bladder prolapse and incontinence, cubic, mushroom, and urethral devices must be preferred. The price category of these systems may be higher.
Women have positive opinions about the gynecological ring. Most patients are satisfied with the result of the application. After installing the system, they have the following symptoms:
- perineal pain
- urinary and fecal incontinence
- recurring inflammation of the cervix,
- bleeding from the genital tract.
You can also hear that the ring when omitted leads to frequent infection of the vagina. This is accompanied by itching, burning, profuse discharge. Indeed, with improper use and the absence of periodic sanitation of the genitals, systems create favorable conditions for the development of pathogenic microorganisms. Therefore, doctors strongly recommend wearing a pessary no longer than the prescribed period and regularly treat it.
The use of the pessary makes it possible to postpone surgery for prolapse of the uterus for a while. This is especially necessary for women with stage 3 and 4 of the pathological process.
Patients also talk about continuing to wear the system after surgical treatment. The ring relieves the muscles of the pelvic floor and prevents recurrence of prolapse. However, in this case, it is necessary to choose another ring, since for each stage of displacement of the pelvic organs, the shape and size are selected individually.
What does the uterine ring look like (pessary)
Gynecological or uterine rings (pessary when the uterus is lowered) allow you to keep the body of the uterus in a natural place. Silicone or latex devices are inserted into the vagina by a doctor in a clinic setting. Thanks to the elastic and elastic structure, they fix the organ in the right place and prevent its displacement. The material of manufacture has a number of undeniable advantages. It is safe and hypoallergenic. A medical device, as a rule, does not cause discomfort, helps normalize vital activity, and does not interfere with the usual course of life. The mobility of the uterine pessary is ensured by the flexibility of the material, due to which, when it enters the vagina, it easily takes the form and the desired position.
Advantages and disadvantages
If the ring during the loss of the uterus brings discomfort, it shifts during any movements, this means that it is incorrectly selected. In some cases, in order to make the right choice, numerous samples of various types of this agent may be required. The gynecological ring is often used by patients and this allows you to evaluate a lot of advantages of using:
- it becomes possible to fix the organ without surgical intervention,
- effectively correct pathology at different stages of manifestation,
- eliminate the possibility of injury to the penis,
- it is easy to use, with the right size.
The device has some disadvantages, forcing women with a similar diagnosis to abandon them. The reasons may be the appearance of:
- inflammation of the vagina and other genital organs. In adulthood, mucous membranes are vulnerable to the effects of pathogenic bacteria and, therefore, women may experience internal damage from contact with the ring,
- discomfort and discomfort. This is due to increased discharge, problems in close relationships with a partner,
- psychological difficulties. Many women do not accept the presence of foreign bodies in the vagina.
There are cases when the use of the pessary not only delayed the operation, but also eliminated the need for it. This becomes possible if you supplement the wearing with special exercises to strengthen the pelvic muscles.
In gynecology, various types of pessaries are used. They differ, depending on the diagnosed form of prolapse, the individual anatomical features of the structure of the internal organs of a woman, as well as with the accompanying problems of urination.
There are several types of pessaries - the ring and the ring is thick. This type is used for mild and moderate degrees, has an internal elastic element, which helps to effectively correct the omission of the uterine body.
Cup and cup perforated pessary used for mild to moderate prolapse.
Urethral has a special device that supports the urethra. It is used for urinary incontinence caused by prolapse of the uterus.
Urethral pessary used for mild to moderate degree of omission. It has the shape of a bowl and helps maintain the urethra and exclude urinary incontinence.
Pessary hodge - an elastic device helps in cases where there is no opportunity to use the usual means. It is used in the severe form of prolapse of the uterus, in identifying the anatomical structural features of a woman. It is made in the form of a ring, inside of which there is elastic reinforcement, which allows changing and giving the necessary shape to the structure.
Cervical perforated pessary made in the form of a deep bowl. It has a large main and small holes in a circle. The device helps to correct the prolapse of the uterus with a moderate degree, and is also actively used as a prophylactic to prevent early delivery in women with a short cervix.
Pessary cubic and cubic perforated made in the form of a cube, but without sharp corners. There are holes for the outflow of vaginal discharge. A strong thread is provided for convenient removal of the device from the vaginal cavity. These models are used for severe degrees of prolapse and are intended for use in a short time (from 6 to 12 hours).
Mushroom pessary has a mushroom-like configuration. At the base of the leg thickening. Designed for the deepest possible insertion into the vagina. This type of device is used for a short time when it is not possible to apply traditional forms. It is set for daylight and is removed at night.
All designs have a size that is very important and is selected individually. The parameters obtained as a result of clinical calculations of vaginal capacity are taken into account. It is carried out using special fitting rings. Self-determination of size is fraught with consequences that promise the inefficiency and ineffectiveness of using this device.
Indications for use
You need to start using the ring with prolapse in the initial phase of the disease. An analysis is performed before the procedure. Make a smear fence for various infections. There are cases when the doctor without fail prescribes the use of the device. It:
- categorical refusal of the patient from surgery,
- the need for preliminary treatment of prolapse of the uterus before surgery,
- significant prolapse or prolapse of the uterus,
- need for analysis after surgery,
- Ideal way to save pregnancy.
Despite the excellent characteristics and significant help to a woman, the uterine rings have some contraindications. They are not recommended for:
- pathologies of the development of genital organs,
- cervical erosion,
- scoop up
- inflammation of the cervix
- various formations in the pelvis,
- bleeding with unknown causes,
- acute infectious diseases.
When using the product, a side effect may occur. As a result, inflammation of the urinary canal or the walls of the vagina may occur in places of contact.
How to use
The doctor or patient under his supervision should pick up the device, first install and remove the gynecological ring. The main task of the pessary is to keep the uterus in the correct position. In this regard, there should be no discomfort or inconvenience when worn. Stages of the procedure:
- since the rings are non-sterile, before using it is necessary to thoroughly wash the product with soap. This is done before and after each use.
- to avoid injury and to avoid internal damage, it is necessary to lubricate the device with special compositions that facilitate sliding,
- before the introduction of funds, the position-changing organ is returned to its natural position. The patient is in the gynecological chair, in cases where the procedure is carried out in the clinic and lying on his back at home,
- the ring is squeezed into the vagina. It is unclenched inside. It is important that the device does not crash, and firmly touches the cervix. Only after performing all actions, you can rise.
Many women have already been able to evaluate the positive effect of the use of the pessary when lowering the uterus. Numerous reviews left by women on various Internet resources confirm this.
After diagnosis, moderate uterine prolapse and, on the advice of the attending physician, acquired a gynecological ring. Along with this, the doctor has developed an individual set of exercises to strengthen the pelvic muscles. Very meticulously fulfilled all appointments and within 1 year she was able to completely abandon the device. At the same time, she avoided surgery, which is recommended in such cases. I want to give advice to women with a similar problem! If you choose the right tool, then there is no discomfort, nothing prevents, but rather helps to cope with the serious problem of prolapse of the uterus.
I bought a pessary for my mother - a woman aged 75 years. She was diagnosed with severe prolapse accompanied by urinary incontinence. We bought a cup-urethral pessary, which helps to keep the urethra, which eliminates urinary incontinence. I won’t go into details about how difficult and uncomfortable it was to live without him, and how my mother’s life changed after his purchase. Thanks a lot to the doctor who recommended the remedy, because my mother categorically refused the operation, and all the hardships of her illness fell on my shoulders.
My pregnant daughter had a serious problem - the possibility of premature birth at 25-26 weeks was not ruled out. I learned about the existence of the pessary from the doctor, and managed to solve this issue with "little blood." We purchased and introduced the device into the vagina, which made it possible to support the uterus from the inside. The daughter safely endured her grandson, and now he is our happiness and joy. I was surprised that the solution to a serious problem lay in such an elementary remedy.
Before you buy rings when the uterus prolapses, you can, along with the characteristics and properties of the device, monitor the prices of various sellers. The device can be bought in pharmacies, where the cost varies, depending on its type, manufacturing material, size and costs from 15 to 100 cu
No need to save on your own health. By acquiring a pessary, you will get rid of the discomfort that has plagued you for a long time, improve the quality of your life, and in some cases completely get rid of years of developing problems.
Causes of prolapse of the genitourinary tract in women
prolapse, prolapse of the uterus
Prolapse is diagnosed with relaxation of the abdominal muscles and pelvic. This happens due to abdominal pressure, in which the ligaments lose their elasticity and become unable to hold the uterus, vagina and bladder. For this reason, the muscle tone of the perineum decreases and a prolapse occurs.
In older women, the muscles that support the uterus and hold the normal position of the walls of the vagina stretch and the genitals lower, sometimes completely falling out through the genital gap. Also, omission and premature opening of the uterus can be observed in women during the period of gestation of multiple pregnancy and with a tonus of the uterus.
The factors that influence the development of genital prolapse in women are most often referred to:
- Long and difficult birth, with varying degrees of trauma. It should be noted that complicated births cause prolapse in almost half of patients.
- Connective tissue problems.
- The decrease in sex hormones, in particular this happens during menopause.
- Pathologies of a chronic nature, which are accompanied by high intra-abdominal pressure (severe cough with bronchial asthma, regular constipation, etc.)
- Failures in the circulation of blood and lymph of the pelvic organs.
- Decreased motor activity.
- Too much weight or sudden weight loss.
- Certain oncological diseases of the reproductive system.
- Regular, heavy physical exertion.
- Hereditary factor.
- Some female operations and surgical interventions on nearby organs.
Types of pelvic organ prolapse in women
This pathology has the property of affecting the front, middle or back of the pelvic floor. Depending on this, several types of pathology are divided:
Prolapse of the anterior section includes:
- Urethrocele (the anterior wall of the vagina and urethra is lowered)
- Cystocele (diagnose parallel prolapse of the anterior vaginal wall and bladder)
- Cystourethrocele (combines the two previous pathologies)
The above types of prolapse are characterized by difficulties with urination, the development of cystitis and infectious pathologies of the urethra. In this case, the uterus has the correct position. This is due to the non-retention of the bladder and vagina by the musculo-ligamentous apparatus. The urethra or bladder descends to the front of the vagina, lowering it down to the genital fissure. In a critical situation, the bladder falls out with the vaginal wall completely out. Basically, this type of prolapse accompanies women during menopause, and there is also a high risk of its development in women with difficult births, which were accompanied by severe ruptures and injuries.
Middle prolapse is:
- Prolapse and prolapse of the uterus.
- Prolapse of the vaginal dome, this condition is fixed after resection of the uterus and its neck.
- Enterocele. Bulges of intestines through Douglas pocket.
With prolapse of the middle section, uterine prolapse (metrocele) is most often diagnosed. With the correct condition, the uterus is fixed by the ligamentous apparatus and facies of the pelvic floor. If these structures are damaged, its prolapse develops, which in many cases is fraught with complete prolapse of the organ. Several degrees of pathology are noted:
1 - the uterus or its neck descends to the level of exit from the vagina.
2 - when straining or heavy loads, it is possible to show the organ from the genital gap.
3 - partial uterine prolapse is noted.
4 - the organ goes completely out.
With prolapse of the posterior part, rectocele is usually diagnosed (bulging of the rectum due to weakening of the back wall of the vagina. At the same time, ladies complain of intestinal upset, constipation, discomfort in the anus. Pathology develops gradually, at the initial stage, the disease can only be detected by palpation during rectal examination. The first sign is stool disorders, incomplete emptying of the rectum. In the future, patients find a disorder in the act of defecation, a feeling of incomplete emptying, pain At this stage, the protrusion of the rectum reaches the level of the vagina. In severe illness, it falls out and the posterior wall of the vagina beyond the boundaries of the genital fissure. Anal fissures, chronic hemorrhoids, etc. are related to rectocele complications.
Symptoms of pelvic prolapse
At the beginning of the development of pathology, the representatives of the weaker sex practically do not notice the ailment. The first symptom, especially in young women, is a significant decrease in the quality of sex. For the most part, this is not manifested by muscle contraction, some problems with orgasm, etc.In the case of using tampons during menstruation, quite often the discharge goes outside, this is due to the fact that the walls of the vagina are stretched. Pain in the lower back and sacrum is also noted, there is a constant sensation of a foreign object in the vagina.
More pronounced signs when the disease begins to progress are considered pelvic disorders. They are manifested by enuresis, in certain cases, gas and stool incontinence, frequent urination, various kinds of problems with the intestines and urethra. There is discomfort when walking and sitting. With the aggravation of the situation, an unpleasant phenomenon is observed - the sensation of organ prolapse in the perineum, it is also accompanied by a decrease in blood flow, the onset of soreness, atrophy, and the inflammatory process. In addition, when emptying the bladder or intestines, the patient is forced to resort to the help of her hands. This condition almost always prevents women from having sex.
How to treat prolapse in women: a pessary will save you from surgery
Medicine offers two main therapeutic methods for eliminating pelvic prolapse:
Surgery is indicated in severe forms. It represents various kinds of operations in which they use their own fabrics, as well as various synthetic nets. Although operations are considered an effective option in this case, they are often fraught with complications and relapse of the disease.
Conservative therapy excludes the use of any medications or recipes of traditional medicine, since there are no alternative or medication in order to eliminate this cause. With conservative treatment, it is recommended to change the lifestyle, that is, reduce physical activity, remove extra pounds, take preventive measures to eliminate constipation, etc. Also, a special physical education that helps train the pelvic floor muscles is an element of this treatment. In addition, an essential part of the conservative method is the wearing of certain bandages and pessaries.
Using pessaries for prolapse
To solve the problem of omission of the internal genital organs without surgery, the installation of a special restraining device - a pessary can. The practice of using pessaries for this pathology has been known since past times, this technique is relevant in our days.
These products are elastic rubber structures of various shapes and sizes that are inserted into the lumen of the woman’s vagina and support the uterus and vaginal walls, preventing them from drooping. The installation of the pessary is considered a temporary supportive measure, but in some cases it is the only way available for a woman to maintain the normal anatomical position of the organs of the reproductive system.
Pessaries are prescribed to patients with various forms of prolapse, and they also help to cope with urinary incontinence. The present products are made from high-quality silicone rubber, which is flexible, does not cause allergies, significantly reduces the risk of complications, creates comfortable conditions for patients.
There are a considerable number of such products, the most used of them are:
- Silicone ring. This species has a thin or thick shape, presented in different sizes. A thin ring is prescribed with a slight vaginal prolapse, a thick one with an average degree of pathology.
- Cup and cup perforated pessary. Such models are available in the form of thickets, with a small inner hole, and also vary in size. Recommended for moderate to mild pelvic prolapse.
- Atretral and calyx-urethral pessary. They differ in thickened forms, designed to correct prolapse, as well as in case of involuntary urination.
- Pessary hodge. This is a unique silicone ring with which you can get any shape. Most often used for patients in whom, due to physiological characteristics, the standard forms are not suitable, as well as in severe stages of the disease.
- Mushroom. It resembles the shape of a mushroom on a leg, intended for deep introduction into the vagina, it is used for a short time, it is prescribed in cases where other species are not effective.
- Cubiform. Assign for temporary use (no more than 5-12 hours), has a cubic shape with concave edges, equipped with a special thread.
It is not easy to choose a pessary; for this, the specialist carefully examines the patient and takes into account its anatomical characteristics, the severity of the disease, and related disorders. The selection of this product occurs during the study of the capacity of the vagina using special rings. With the right choice, the pessary should be kept under straining, not to create discomfort, pain and difficulty urinating. In addition, an additional technique is the use of two pessaries simultaneously, this option is extremely rare, but it helps to cope with the treatment of severe forms.
pessary gynecologist appointment
Features of installing and removing the supporting pessary
When the doctor prescribes the installation of a pessary, first of all, the type and shape of the product is determined. In modern gynecology, pessaries-rings, which are multiple oval compartments combined in one structure, are most often used. Next, the doctor treats the pessary with an antiseptic and lubricates with a special gel that facilitates its introduction into the vaginal lumen. After the device is installed in place, it is not felt by the patient and completely takes the form of a vagina.
In some cases, pessaries of the “donut” or “barrel” form are used, which better support the walls of the vagina. Depending on the choice of form, size and purpose of the pessary, it can be installed on an ongoing basis with replacement once every few weeks or months, or for periodic wear. For example, pessaries during pregnancy can be installed and removed only by a gynecologist, while pessaries in age patients are often removed and inserted several times a day at the request of the woman herself. This is especially true for the fair sex, who lead an active sex life, since the pessary is an obstacle to vaginal sex.
The duration of continuous use of the pessaries in each case is individual. On average, patients use it for 35-40 days, with the exception of those forms that are forbidden to use for a long time. As a rule, during their installation, a control inspection is carried out after 1-2 weeks.
The main advantages and disadvantages of pessaries
The advantages of this technique include:
- Fixation of organs without surgical intervention.
- Possibility of adjustment.
- Lack of injury.
- Ease of use and a wide selection of products.
The disadvantages include the fact that pessaries, if they are not installed correctly, can cause inflammation of the vagina, especially in older women. Young women often have problems with sexual contact, as well as minor discharge. Also, in certain cases, the psychological factor sometimes makes it impossible to use this tool. If the above problems occur, women need to visit a gynecologist, who, with timely treatment, will help to quickly eliminate such an unpleasant pathology.
The process of installing and changing the pessary is completely painless and safe. BUT, only an experienced gynecologist can prescribe the use of this supporting element and give recommendations regarding its use. It is precisely such specialists who make an appointment at the Diana Medical Center.
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Causes of Uterine Prolapse
A key role in the development of this pathology belongs to the weakening of the muscles and ligaments of the diaphragm, the anterior abdominal wall, and the pelvic floor, which lose the ability to hold the pelvic organs in a normal anatomical position. In situations of increasing intra-abdominal pressure, the ligaments cannot provide the necessary resistance, which gradually leads to a displacement of the genital organs downward.
Weakening of the muscular and ligamentous apparatus develops as a result of birth injuries, multiple pregnancies, perineal tears, multiple births, radical interventions on the pelvic organs, and the birth of large children. Uterine prolapse is also preceded by an age-related decrease in estrogen levels, a weakening of one's own uterine tone.
A pronounced load on the pelvic muscles develops with excess weight, in conditions that are accompanied by an increase in pressure inside the peritoneum (cough, chronic bronchitis, ascites, constipation, pelvic tumors, etc.). The cause of uterine prolapse is also hard physical labor. More often, pathology occurs in old age, but it can develop even in young nulliparous women.
Silicone uterine ring can be either rubber. It is inserted inside the vagina in order to support the pelvic organs - the uterus, rectum, and bladder. In addition, such devices are used to prevent the progression of the pathological process, normalize the patient’s well-being, and relieve uncomfortable sensations. In modern gynecology, this technique is also used to lower the uterus, its shift towards the vagina, and also during prolapse. The uterine ring with prolapse of the uterus, according to reviews, is an effective way to prevent complications of an inflammatory nature.
Indications for use
Vaginal rings for the uterus are recommended for use in the presence of the following clinical indications and diseases of the female genital area:
- Prolapse of the uterus.
- The movement of the uterus outside the vagina.
- Uterine prolapse, which is characteristic of women aged 45-50 years.
- Female genital therapy before surgery.
- The presence of contraindications for operations on the genitals.
- The need to maintain pregnancy, including multiple pregnancy.
- Diagnosis of urinary incontinence, which occurs in a chronic form.
- Prevention of premature birth.
- Displacement of the urethra, which is accompanied by urinary incontinence.
- Consolidation of the therapeutic result obtained during surgical procedures.
- Uterine prolapse with urinary incontinence.
The uterine ring with prolapse of the uterus helps to cope with the pathology even at the most advanced, severe stage of the disease. Uterine pessaries help patients forget about pain and discomfort, lead a full life.
During pregnancy, the establishment of the uterine ring should be indicated if there are such clinical indications:
- Violation of the functional indicators of the ovaries, which occurs in severe forms.
- Isthmic-cervical insufficiency, which contributes to the softening of the cervix and its premature opening.
- The presence of a history of spontaneous miscarriages, premature birth, abortion.
As a prophylactic, uterine pessary is recommended to be used after cesarean section, with excessive physical exertion.
Types of uterine pessaries
Gynecological pessary is a device, the introduction of which allows you to keep the uterus in the correct position. Materials such as silicone and latex are used to produce rings. They are hypoallergenic and have high safety and quality indicators.
The pharmaceutical market today presents several types of gynecological uterine rings. Each of them has its own characteristics and is used in various clinical situations:
- The urethral rings have a round shape and a thickening on the outside. Such pessaries contribute to concomitant fixation of the uterus and urethra.
- Mushroom - similar to a ring that has a leg. These types of devices are used only in extreme cases, when other devices do not have the necessary therapeutic effect. The maximum wearing period for such a ring is no more than one day.
- Cubic rings resemble a cube whose walls are concave inward. These varieties are equipped with special holes that allow you to remove secretions from the genitals, and are used in the most advanced and severe clinical cases. In addition, uterine cubic rings have a limited duration of use.
- Cup pessaries are uterine rings that have a characteristic cup-shaped shape with a hole in the center. They are indicated for use in cases of prolapse of the uterus at the initial or secondary stage.
- The Hodge ring is a device intended for use by patients who have some anatomical features, due to which the use of other rings gives pronounced discomfort. Such a pessary is characterized by an irregular circumference, increased elasticity, flexibility and the ability to accept various configurations.
- Urethral-cup - rings that combine the properties of the urethral and cup gynecological pessaries. Their wearing is recommended for minor and medium stages of prolapse of the uterus with the accompanying violation of urinary incontinence.
In addition, the uterine rings are thick and thin. The most optimal option is chosen by the doctor depending on the characteristics of a particular clinical case.
Sizes of uterine rings
The size of the pessary is fundamental. And to determine the necessary independently is almost impossible. The appropriate size of the uterine ring and shape should be determined exclusively by the attending physician after preliminary diagnostic procedures. The size of the ring on the package corresponds to its diameter (from 55 to 95 mm).
With the omission or slight loss of the uterus of the first or second degree, the use of a support ring for the uterus is recommended. Pregnant women are prescribed the use of special obstetric rings. In case of problems with urination, uterine rings that are equipped with a special levator are recommended. If the pathological process reaches the third or fourth stage, the most optimal option is a gynecological pessary of a cup-shaped type.
How to establish a gynecological ring?
Consider the instructions for use. In case of uterine prolapse, the uterine rings must be learned to administer on their own, since this device is used at home. Initially, such a procedure is carried out under the supervision of a medical specialist. Some varieties are placed in the vagina by the gynecologist once and subsequently do not require extraction and a new installation.
So, how to enter the uterine ring with prolapse of the uterus?
The procedure is performed in several stages:
- Thorough treatment of the uterine ring with soap and water, rinsing with water and disinfection.
- Processing the pessary with a special vaginal lubricant or cream for a more comfortable and easy installation, preventing trauma to the mucous membranes and skin.
- Next, the pessary is clamped in the palm of your hand, inserted into the vagina, and then the device is straightened so that it contacts the cervix and does not exert excessive pressure on it. Installing the fallopian ring is not too complicated.
The duration of use of the gynecological device depends on its variety, the patient's pathologies and individual characteristics, including anatomical ones. Most gynecological rings (with the exception of the cubic and mushroom) are allowed to be used for a sufficiently long time period - about 1.5 months. After about 1.5-2 weeks, the patient should see a doctor for a follow-up examination.
A scheduled visit to the gynecologist should occur a month after using the pessary, after which - after 3 months.
How to introduce the uterine ring when the uterus prolapses is a common question, since various devices are used in different ways. Some varieties of pessaries are suitable for constant wear, which requires regular monitoring by a gynecologist. Some models are used exclusively for increased physical exertion, but most uterine rings require daily wear. In this case, the pessary must be pulled out daily, treated with antiseptics and injected back into the cervical region.
Disadvantages and advantages
Gynecological devices in the form of uterine pessaries are characterized by the following advantages:
- The possibility of the necessary fixation of the urethra and uterus in cases where surgical intervention is contraindicated.
- Convenient and simple operation with the right size and shape of the gynecological device.
- High performance indicators at different stages of the pathological process.
- Lack of likelihood of traumatic damage to the genitals.
- The minimum list of contraindications and possible adverse reactions.
This method of therapy for uterine prolapse and other pathologies has some disadvantages, among which the following are considered the main ones:
- Sexual problems.
- Possible development of inflammatory processes.
- It does not completely solve the problem, since when the uterine ring is removed, the pelvic organs return to the wrong position.
- It requires regular care and treatment with antiseptic agents, as well as regular sanitation of the vagina.
- Possible increased vaginal discharge and uterine bleeding.
Some women, according to reviews, from the uterine ring during prolapse of the uterus experience psychological discomfort due to the presence of a foreign body inside the vagina.
How to extract?
How to put a uterine ring, the gynecologist will tell the patient. He will also explain how to further independently remove the system and install it again. The bulk of these devices are easy to install, so difficulties during this process, as a rule, do not arise.
To remove the gynecological ring, you must squat or raise one leg. With the index, thumb and middle finger, the pessary is captured and gradually removed from the vaginal cavity. This should not cause a woman unpleasant sensations. After that, the pessary is cleaned, according to the information directly provided in the instructions for use. The introduction of the uterine ring should be carried out in a prone position. For this, it is necessary to lubricate the gynecological device with a special cream or lubricant to facilitate sliding and prevent injuries of the vaginal mucosa. This is confirmed by the instruction for the uterine ring.
When the uterus prolapses, depending on the degree of pathology, the specialist sets the time period during which the device must be used. It is advisable to do this during the period of physical activity and wakefulness. Typically, patients are prescribed to wear a gynecological pessary during the day, and in the evening to remove it. The course of use of such a device is also determined individually.
The gynecologist can prescribe the wearing of the uterine ring for 1-5 months or recommend its use for life. It should also be remembered that all varieties of pessaries intended for use with prolapse of the uterus increase the likelihood of developing inflammatory processes in the vagina. Therefore, it is recommended that all patients periodically carry out sanitation of the genital tract with the help of special medications. For these purposes, most often used candles "Hexicon" or a solution of "Miramistin." If infectious pathologies occur and local microflora change, other drugs for local treatment can also be prescribed - antiviral, antibacterial, antifungal.
The price of the gynecological pessary depends mainly on the manufacturer, the shape and material of manufacture. Today, the most popular companies are Juno and Dr. Arabin. The cost of a uterine rubber or silicone ring starts from 300 rubles and reaches several thousand.
If the patient is going to install a pessary in a private clinic, then this will also be a paid procedure - from 500 to 3000 rubles.
It is necessary to select a supporting gynecological system taking into account the stage of prolapse of the uterus, the age of the patient, the presence of concomitant diseases and the number of births in history. With uterine prolapse and prolapse of the bladder with urinary incontinence, mushroom-shaped, cubic and urethral uterine pessaries are preferred. The price category of such systems is usually much higher.
Reviews of uterine rings in case of prolapse
Most women who used the pessary had a positive opinion about it. Mostly ladies are satisfied with the result of use. After installing the systems, they observed the elimination of the following unpleasant symptoms:
- perineal pain
- recurrent inflammatory processes affecting the cervix,
- fecal and urinary incontinence,
- bleeding from the genital tract.
Often you can hear that the pessary during prolapse or prolapse leads to infection of the vagina, which is accompanied by burning, itching and profuse discharge. This is true, especially with improper use and the absence of regular debridement of the genitals. Moreover, such gynecological systems are able to create favorable conditions for the propagation of pathogenic microorganisms. In this regard, experts strongly recommend wearing this device for no longer than the specified time interval and thoroughly process it.
According to reviews, the uterine ring with prolapse of the uterus makes it possible to postpone surgery for some time. This is especially necessary for patients with the 3rd and 4th stage of development of such a pathological process. Women also say that they continue to wear uterine rings even after surgical treatment. The pessary significantly relieves the muscles of the pelvic region and prevents relapse of prolapse. However, in this case, it is absolutely necessary to choose another device, since for each degree of displacement and prolapse of organs, the size and shape are selected individually. Instructions for use of the uterine ring must be strictly observed.