ask: Does anyone have any information on using a pessary for a cystocele?
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The American Academy of Family Physicians has a lot of information and diagrams:
http://www.aafp.org/afp/20000501/2719.html
The AAFP says the pessary is an effective tool in the management of pelvic support defects such as cystocele (which is also called prolapsed bladder). The diagram pictures various types of pessaries (over 20, in fact!):
"FIGURE 1. Various types of pessaries: (A) Ring, (B) Shaatz, (C) Gellhorn, (D) Gellhorn, (E) Ring with support, (F) Gellhorn, (G) Risser, (H) Smith, (I) Tandem cube, (J) Cube, (K) Hodge with knob, (L) Hodge, (M) Gehrung, (N) Incontinence dish with support, (O) Donut, (P) Incontinence ring, (Q) Incontinence dish, (R) Hodge with support, (S) Inflatoball (latex)."
The Mayo Clinic says that a pessary is an alternative to surgery:
"Pessary. A vaginal pessary is a plastic or rubber ring that's inserted in the vagina to support the bladder by pushing it up and back into place. In some cases, your doctor may recommend using a large tampon or vaginal diaphragm instead of a pessary. Most women who use pessaries do so as a temporary alternative to surgery. But some women may use pessaries for years.Pessary. A vaginal pessary is a plastic or rubber ring that's inserted in the vagina to support the bladder by pushing it up and back into place. In some cases, your doctor may recommend using a large tampon or vaginal diaphragm instead of a pessary. Most women who use pessaries do so as a temporary alternative to surgery. But some women may use pessaries for years.
http://www.mayoclinic.com/health/cystocele/DS00665/DSECTION=treatments-a...
What has your doctor said about your cystocele?
October 2, 2008 - 1:58pmThis Comment
I had a hysterectomy 15 years ago for a uterine prolapse and now the cystocele , which was diagnosed then, is becoming pretty severe. I was told by a few physicians that a pessary may not work because I had a hysterectomy. Is this true ? Are there any pessaries that would be more effective than others for women who have had hysterectomy? I have tried estrogen creme for the past year and it provides only minimal support.
November 23, 2009 - 4:35amMs Jane - That's a good question. Web MD agrees with the physicians you've talked with, and provided the following information:
A pessary may not be a good choice after having a hysterectomy. This is because the walls of the vagina are no longer held in place by the uterus and cervix. Women with severe prolapse following a hysterectomy may have difficulty keeping the pessary in place.
Have you asked about any other options? There may be other solutions for you, depending on your general health, age, the severity of your symptoms, personal preferences and other factors. I would encourage you to talk to your healthcare practitioner about additional treatment options. We'd be happy to assist you with research about those options once they're been identified and work with you to obtain greater support. Thanks for writing! Pat
November 25, 2009 - 6:23pmThe first OB/Gyn Dr. I saw said I had a mild cystocele and didn't recommend anything. I went to a urogynecologist and he said the new robotic sacrocolpopexy was the way to go. He down played the use of a pessary. I told him of my fear of surgery due to previous complications from hysterectomy . At that time one of my ureters was severed and the Dr. didn't even know it. I became incontinent several weeks after the hysterectomy and had to have additional surgery by a urologist. Then an intestinal obstruction. I almost died. I would like to try anything first before having surgery. If only I could find a Dr. willing to fit me with a pessary. I read that someone used a large tampon and that helped. Any suggestions?
June 21, 2010 - 9:22amHi Dery
Pessaries are still in use and if you would rather try that first, your physician should be willing to fit your or give you a good, detailed explanation as to why it is not going to be safe or effective for you.
I found a couple of links for you. There are more, but these seemed good and current. The first is a patient education pamphlet from the American Congress of Obstetricians and Gynecologists: http://www.acog.org/publications/patient_education/bp012.cfm.
The next is an article from the American Family Physician journal called Practical Use of the Pessary: http://www.aafp.org/afp/20000501/2719.html.
I suggest you take this information back to the doctor and ask why exactly he feels you should not try a pessary before surgical intervention. If there is no danger to you in doing so and it's just his preference, push for what you want and if it means seeing a different physician, I suggest that you do so.
Thank you for the question and please let us know how it goes.
June 21, 2010 - 2:59pmSorry to take so long in replying. I have had great success using a pessary. I went to a urologist and was fitted. I was instructed on putting it in and taking it out and the care needed. Now I go once a year for it to be checked. I am 82 yrs. old and I am very active. I line dance two hours a week and walk a lot. I discussed the use of a pessary with my internist and he agreed with me about talking to a urologist. I have known women who have had surgery for the cystocele and in a few years they have to have it again. I did have a hysterectomy 33 yrs. ago. I know all women are not the same but I think some doctors are too quick to operate. There are many factors to consider.
June 12, 2011 - 7:33amThanks for the information. After talking with my doctor, I've decided to go ahead with surgical repair for the cystocele. I will be having surgery January 14 - they will be using a mesh insert - anterior repair, perigee. I'll post about my experience and the results.
December 4, 2008 - 12:14pmThanks for updating us. I hope your surgery goes well on the 14th and we look forward to your next post!
December 4, 2008 - 4:41pmOkay - surgery was in January - it is now March. Surgery was a breeze with no problems. I was in the hospital overnight. The hardest part of the process was doing nothing for 6 weeks! No lifting, no housework, no laundry! But well worth it since it allowed proper healing.
I am feeling great - with no more bladder problems at all!
March 26, 2009 - 1:02pmI have been diagnosed with a prolapse of the vagina. The surgeon proposes a repair that involves abdominal surgery and use of mesh. He dismisses my concern about complications from the use of mesh. I know that the FDA has issued warnings about the use of it in pelvic prolapse surgery. He never mentioned the use of a pessary as an option, (I am 69 yrs. old and had a hysterectomy 19 yrs. ago. Would a pessary be an option instead of surgery for me?
January 30, 2011 - 7:18pm