Childbirth that occurs after the removal of the pessary is no different from ordinary childbirth and the terms are different. The use of pessaries in gynecological practice for the treatment of genital prolapse and stress urinary incontinence

Prolapse of the uterus is the exit of the organ beyond the small pelvis. Most patients with this diagnosis have already gone through menopause. Young women are also not immune from this pathological process. Uterine rings in case of prolapse of the uterus will help to avoid the removal of the uterus and the severe consequences of the operation.

Collapse

Medical certificate

The uterine ring is a gynecological and obstetric equipment made of elastic, safe and hypoallergenic plastic. The best are products made of silicone, polyvinyl chloride and latex. Pessaries are inserted into the vagina and are indicated to maintain the body of the uterus in an anatomically correct position. The product plays the role of support, a kind of crutch for the organ, a supporting element, but is not an independent medical measure. Used in complex therapy.

The gynecological ring, when the uterus is lowered, holds the organ during any movement of the body, allows you to lead an active lifestyle, and does not fall out when moving.

Pessaries are indicated in the following cases:

• prolapse of the 3rd degree - when the uterus enters the vagina;
• prolapse of the 4th degree - with a complete prolapse of the organ;
• when surgical treatment is impossible;
• the desire of the patient to postpone surgical treatment;
• identifying the causes of urinary incontinence;
• pregnancy with miscarriage;
• during preparation for extirpation and in the postoperative period.

Wearing a ring during uterine prolapse can be lengthy. The initial course is 1 month, then a break is taken. Further at the discretion of the gynecologist.

Classification of uterine rings

Various forms of uterine pessaries have been developed. When buying medical equipment for the conservative treatment of uterine prolapse, you should choose the gynecological type of the uterine ring, since the obstetric one is indicated for use in miscarriage.

In appearance, a gynecological pessary is a plastic ring with a diameter of 50 to 100 mm. The doctor will help you choose the necessary therapeutic device based on the diagnosis of the patient.

With prolapse of the pelvic organs, the types of rings shown in the photo are used:

It is impossible to independently determine the type of medical equipment for maintaining the pelvic organs in a physiological position. Uterine rings for uterine prolapse are produced in different sizes. The wrong shape and diameter of medical equipment will do more harm than good.

When the uterus is lowered, the rings are selected by the doctor according to the diagnosis and the structure of the patient's reproductive system. Medical equipment should be purchased at specialized retail outlets or large pharmaceutical chains.

Rules for installing and using rings

When the uterus prolapses and prolapses, the pessary is installed and removed by the doctor during a gynecological examination. Then he invites the patient to do all the manipulations under his supervision.

The method of using medical equipment for prolapse of the organs of the reproductive system:

1. Before installation, the pessary should be thoroughly washed and treated with an antiseptic. Do not use drugs containing alcohol. Ethanol can damage the structure of the material from which medical equipment is made. It is best to follow the recommendations of a gynecologist.
2. To facilitate insertion, the device is lubricated with a lubricant or petroleum jelly.
3. Set all organs in the correct physiological position. Then start the procedure for introducing the uterine ring.
4. The pessary is squeezed with one hand and inserted into the vagina. Straighten the uterine ring in case of prolapse of the uterus already directly in the neck of the organ
5. In a hospital, this procedure is performed by a doctor in a manipulation room. At home, lie on your back and bend your knees.

After that, the patient can get up. The device should not cause discomfort, feel like a foreign body, or push or slip when urinating or defecation.

If there are signs of discomfort or any other unpleasant symptoms - pain, cramps, profuse secretion or the appearance of blood - the device is removed.

1.5 weeks after the installation of gynecological equipment, you should contact a gynecologist to assess the condition of the mucous membranes of the vagina, cervix, and the reaction of internal organs to a foreign object. A second appointment is carried out in a month, then you will have to appear at the gynecologist 1 time in 3 months.

Important! The mushroom and cubic pessaries should be removed at night. All other forms are allowed to be used within 30 days.

When is it forbidden to use a pessary?

There are a number of contraindications to the use of supportive medical equipment in the treatment of uterine prolapse.

Uterine rings for uterine prolapse are contraindicated in the following categories of patients:

• individual intolerance to the material of the ring;
• anomalies of the organs of the reproductive systems;
• erosion;
• colpitis, other pathologies;
• neoplasms of any genesis;
• infection;
• bleeding from the vagina of any etiology.

During treatment with uterine rings, there is a possibility of developing inflammatory processes in the urinary system. This is due to the constant pressure of the medical device on nearby organs. If the rules for processing the pessary are not followed, the risk of infection of the organs of the reproductive system with pathogenic flora increases.

Pros and cons

The use of medical equipment in the treatment of prolapse of pelvic structures has both positive aspects and a number of disadvantages.

Positive aspects of the pessary:

• alternative to organ extirpation;
• effectiveness with varying severity of the disease;
• there is no risk of injury to the pelvic organs;
• the installation procedure is non-invasive, does not require a hospital stay;
• ease of use.

Despite the convenience, simplicity and proven clinical efficacy, the use of uterine rings has a number of negative consequences.

Negative aspects of using the equipment:

• development of inflammatory processes in the vagina, cervix;
• discomfort during use;
• difficulties in intimate life;
• stretching of the walls of the vagina, which increases the risk of damage by pathogenic flora;
• psychological discomfort due to the awareness of the presence of foreign equipment in the vagina.

The diagnosis of "uterine prolapse" does not mean that the patient is doomed to discomfort, pain and the procedure for removing the organ. The installation and use of a pessary, along with the implementation of a complex of exercise therapy, can not only delay surgical intervention, but also completely remove the issue of hysterectomy.

Or uterine prolapse is a fairly common pathology that is most often diagnosed in older women, but this ailment is also not uncommon in women of the reproductive period.

For a long time, prolapse may not be accompanied, and a woman may not even be aware of it.

But with the progression of the disease, the symptoms intensify, causing the patient significant discomfort, and without treatment, the consequence of prolapse can be disability.

In this article, we will look at one of the ways to deal with prolapse - the use of a pessary or intrauterine ring.

Essence of pathology

The genital organ in the pelvic cavity is held by the ligamentous apparatus and the muscular corset. If the tone of the muscles and ligaments weakens, the organ begins to change its anatomical position, going down.

The situation is aggravated by pressure on the uterus of other organs of the pelvic and abdominal cavity. At the same time, the uterus itself begins to exert increased pressure on the rectum and bladder, thereby provoking various pathologies in these organs - difficulty urinating, cystitis, constipation, fecal incontinence, and so on.

Doctors distinguish the following degrees of the pathological process:

• - the organ prolapse is insignificant, the cervical region approaches the genital slit, but does not go outside;
• - a more significant prolapse, in which, when straining or coughing, the cervical region may go beyond the vaginal limits;
• third degree- reproductive organ. The cervical region and part of the body of the uterus protrude beyond the vagina;
• fourth degree or - the uterus is completely out of the vagina.

Despite the absence of a threat to a woman's life, uterine prolapse can be fraught with various complications that can significantly worsen the patient's quality of life, as well as lead to various concomitant ailments.

What is a pessary?

Simply put, a pessary (pisarium) is an elastic ring that is actively used in gynecological practice for various pathologies, including uterine prolapse.

The gynecological ring is made of biologically pure and safe materials. Most often it is silicone or a special plastic that has high ductility. Such materials easily take the form of a woman's genitals, which means that their use will not cause discomfort.

The pessary is sold sterile, but you should check the expiration date before purchasing the product. All edges of the ring are smooth, they tightly fit the cervix, keep it from prolapse and prevent its disclosure.

The device has holes for vaginal discharge.

Why is it needed?

Of course, surgical treatment of prolapse (for example, when a mesh is installed) is the best option for solving the problem of uterine prolapse, but in most cases it is used in relatively young patients.

Elderly women undergo surgery much less often. This is due to various contraindications and background diseases of patients. At the same time, prolapse is most often diagnosed after menopause, which is due to the involutional processes occurring in the woman's body.

Conservative methods do not always give a positive result, and then the pessary is the most effective alternative to prolapse.

Medical technologies do not stand still, and new materials and forms of the pessary are currently appearing, which makes this device more and more popular and in demand.

An intrauterine ring or pessary is the only way for many women to lead an active and fulfilling life. But before deciding to install it, a woman must understand that pessaries are different - some need to be removed and washed every day, while others can be worn all the time. For older women, permanent pessaries are recommended because they may have difficulty reinserting them on their own. In general, this device is convenient to use, safe, and most importantly, it solves the problem of complete prolapse of the reproductive organ. However, the pessary is not only intended for use by elderly patients, uterine prolapse can also be observed in young women, and even when carrying a child, so the pessary can be considered a universal therapeutic device that can solve a large number of women's gynecological problems.

Advantages and disadvantages

Among the advantages of a pessary are:

• partial compensation of prolapse;
• the ability to lead a full life without surgery;
• ease of use and maintenance;
• safety and hypoallergenicity;
• if the device is chosen correctly, the risk of injury to soft tissues is completely absent.

However, there are also negative aspects of using a pessary:

• the amount of discharge when wearing the ring may increase;
• possible difficulties with intimate contacts;
• inability to use in inflammatory processes of the pelvic organs. This is despite the fact that its long-term wearing is indicated for elderly women, in whom the mucosa naturally atrophies, which increases the risk of infection;
• in rare cases, there is a psychological barrier - a woman cannot tolerate the presence of a foreign object in the vagina.

When is a uterine ring required?

The installation of a pessary is necessary in the following cases:

• uterine problems that are not accompanied by other pathologies;
• the inability or desire of the patient to perform surgery;
• it is possible to cure existing gynecological defects without surgical intervention;
• it is necessary to evaluate the effect of the operation;
• in the diagnosis of urinary incontinence.

NOTE!

Before installation, it is necessary to pass a vaginal smear for the presence of infections.

What are the types?

The main types of pessary are as follows:

• supporting - supports the vagina, preventing it from falling;
• thin - worn on the cervix;
• thick;
• cup-shaped - to remove the secret of the gonads;
• cubic;
• filling - does not allow uterine prolapse;
• mushroom.

Which type to use is better, the doctor decides individually in each case.

The photo below shows the different types of these devices.

How is the installation

The primary installation of the uterine ring takes place in the gynecologist's office, in the future the woman must learn to carry out this procedure on her own.

Before the introduction of the ring, it is sterilized or rinsed in boiling water. Then the ring is compressed and inserted as deep as possible into the vagina so that the convex part of the ring is turned towards the neck.

This procedure is carried out in a horizontal position. If the ring is selected and installed correctly, there should be no uncomfortable, and even more painful sensations.

After installing the pessary, the woman should visit the gynecologist every two weeks for two months to control the process and make sure that the device will not lead to complications.

Usually the ring is put on for six months, but for elderly patients it is prescribed for life.

Contraindications

Not in all cases, the uterine ring can be installed safely.

There are a number of contraindications that do not allow its use:

• precancerous condition of the uterus or cancer;
• bleeding;
• genital infections;
• the presence of an inflammatory process.

Also, the installation of the uterine ring is not desirable for women who, for whatever reason, cannot come to the gynecologist at least once every six months.

Women who lead an active sex life are allowed to use the uterine ring only if they know how to insert it correctly on their own.

Reviews of women

Below are the reviews of women about the use of the uterine ring:

(( reviewsOverall )) / 5 Patient evaluation (8 votes)

Evaluation of a drug or treatment

Omission and prolapse of the pelvic organs in women is a common occurrence. In medical practice, this disease is called prolapse. This term defines the prolapse of the small organs (uterus, vagina, bladder), with their subsequent prolapse to the outside.

Pathology can affect not only older women, but also quite young ladies. This condition is not life-threatening, but fundamentally affects its quality. This causes excruciating pain for women, it can also affect urinary incontinence, the appearance of kidney failure, etc.

Even in the time of Hippocrates, pomegranate was used as a pessary, which was previously soaked in vinegar. Over time, the choice of various materials became much larger, people began to use wood, cork, and then rubber for its manufacture.

Today, the gynecological pessary is made of polypropylene and silicone. Time has changed not only the material, but also the very appearance of this device, which allows you to choose exactly what will fit the female problem as best as possible.

The device consists of rings of different sizes, interconnected. For each woman, the doctor will select exactly the size that suits her.

Causes of prolapse of the internal urinary organs in women

Prolapse is diagnosed by relaxing the muscles of the abdominal and pelvic regions. 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 prolapse occurs.

In women of age, the muscles that support the uterus and keep the walls of the vagina in a normal position are stretched and the genitals descend, sometimes completely falling out through the genital gap.

Also, prolapse and premature opening of the uterus can be observed in women during the period of gestation of multiple pregnancies and with uterine tone.

The factors that influence the development of genital prolapse in women most often include:

• Prolonged and difficult childbirth, with varying degrees of trauma. It should be noted that complicated childbirth causes prolapse in almost half of the patients.
• Connective tissue problems.
• Decreased sex hormones, especially during menopause.
• Pathologies of a chronic nature, which are accompanied by high intra-abdominal pressure (severe cough with bronchial asthma, regular constipation, etc.)
• Malfunctions in the circulation of blood and lymph of the pelvic organs.
• Reduced motor activity.
• Too much weight or sudden weight loss.
• Certain oncological diseases of the reproductive system.
• Regular, heavy physical activity.
• hereditary factor.
• Some female operations and surgical interventions on nearby organs.

Types of pelvic organ prolapse in women

Anterior prolapse includes:

• Urethrocele (lowering of the anterior wall of the vagina and urethra)
• Cystocele (diagnose parallel prolapse of the anterior wall of the vagina and bladder)
• Cysto-urethrocele (combines the two previous pathologies)

The above types of prolapse are characterized by difficulty in urination, the development of cystitis and infectious pathologies of the urinary system. In this case, the uterus is in the correct position.

This is due to the non-holding of the bladder and vagina by the musculoskeletal apparatus. The urethra or bladder descends to the front of the vagina, dropping it down to the genital slit.

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.

Currently, there is a whole classification of these gynecological devices.

Supportive - designed to support the uterus, preventing its omission. These include:

• a gynecological pessary with an elevator, which is used in the treatment of incontinence;
• thin uterine rings;
• thick rings;
• bowl-shaped;
• made in the form of a strip.

Filling - are intended to ensure that the walls of the uterus do not sag. They prevent the prolapse of the rectum, as well as the bladder. This type includes:

• thick rings;
• mushroom-shaped inflatable pessaries;
• cube fixtures.

Prolapse and prolapse of the uterus and vagina in most cases is chronic. The disease often begins in adulthood, progresses slowly and, if left untreated, leads to complete prolapse of the genitals and associated problems with urination and defecation.

Constant physical and psychological discomfort, a decrease in the quality of life, social exclusion - all these problems are designed to be solved by a gynecological pessary during uterine prolapse. Treatment of prolapse by installing a supporting pessary is not able to permanently return the pelvic organs to their normal anatomical position, but it allows a woman to lead a normal life, work and communicate with other people.

Treatment of uterine prolapse without surgery is indicated only if, for certain reasons, surgical intervention cannot be performed. Only a surgeon's scalpel is able to get rid of the problem of genital prolapse forever, this must be taken into account when deciding whether to use a pessary.

Classification and selection of a pessary for uterine prolapse

Genital prolapse is classified according to the degree of prolapse of the uterus and vagina in relation to the planes of the pelvis and genital fissure.

I degree of prolapse of the genitals is characterized by some prolapse of the uterus. At the same time, her neck is below the plane of the narrow part of the pelvis and even when straining is not shown from the genital gap, however, there may be a prolapse of the anterior or posterior walls of the vagina.

Pessaries for uterine prolapse of the I degree should perform a supporting function. The placement of a uterine ring for grade I prolapse of the uterus and vagina is usually sufficient to solve the problem. In addition, cup pessaries can be used.

II degree of genital prolapse is an incomplete prolapse of the uterus, a condition in which the cervix, when straining, goes beyond the genital gap, but in the supine position and when performing special exercises returns to the vagina.

In the second degree of genital prolapse, as in the first, you can choose a pessary-ring or "bowl", both of which will provide reliable support to the pelvic organs, will fix the uterus in an anatomically correct position and will not allow the walls of the vagina to fall.

III degree of genital prolapse is a state of complete prolapse of the uterus, when it is completely outside the genital gap at the slightest physical exertion, coughing, sneezing, laughing, and even just when moving from a horizontal position to a vertical one. As a rule, the uterus does not retract on its own. Objectively: a pineal formation protrudes from the genital slit - edematous, cyanotic, often covered with decubital ulcers of the cervix. It is followed by a hernial sac formed by the walls of the vagina, inside which is the body of the uterus. The mucosa of the walls of the vagina and cervix looks smooth, dry, thin, like skin. Omission of the uterus in flight followed by a displacement of the posterior wall of the bladder (vesicocele) and the anterior wall of the rectum (rectocele).

Treatment of uterine prolapse is not an easy task. If the operation is not possible, you have to resort to pessaries, but even here difficulties arise. Before installing a pessary, inflammatory complications of prolapse are treated, in order to install a pessary, it is necessary to restore the mucous membrane of the vagina and cervix, to heal decubitus ulcers.

How to choose a pessary for uterine prolapse III degree? First of all, the pessary must have a filling effect, that is, it must completely occupy the entire volume of the vagina, thereby preventing the uterus and vaginal walls from sinking down. The usual thin gynecological ring with prolapse of the uterus of the III degree will not cope with these functions. The force of pressure of the internal genital organs on the pessary is such that the uterus is easily pressed through the large internal opening of the ring and is infringed in it, which is fraught with necrosis of the organ and the development of serious complications. With complete prolapse of the uterus, the choice should be made on a thick donut ring, mushroom or cubic pessary.

Why is it necessary to use a pessary for uterine prolapse?

Partial and complete prolapse of the uterus is subject to mandatory correction.

• The low position of the cervix and the gaping of the genital slit leads to the fact that the infection easily penetrates into the genital tract, causing the development of colpitis, cervicitis, and even higher - into the internal genital organs.
• The prolapse of the walls of the vagina and the anterior wall of the bladder leads to a change in the anatomical position of the urethra, which leads to the development of stress urinary incontinence. Urine leaks in small portions when coughing, sneezing, straining, lifting weights, and even laughing. The appearance of a persistent smell of urine dramatically reduces the quality of life and limits the ability of a woman to communicate.
• Problems with urination lead to the development of cystitis and pyelonephritis.
• Irritation of the skin and mucous membranes of the genital organs with urine leads to their inflammation, up to pyoderma and eczema.
• The prolapsed uterus and vaginal walls swell and can be infringed in the genital gap. Violation of blood circulation in the organs leads to their necrosis, which entails serious consequences.
• Complete uterine inversion is possible.

The use of a pessary for omission and prolapse of the uterus will prevent the development of complications of genital prolapse.

Many women with age or after past illnesses face the problem of prolapse or prolapse of the uterus - prolapse. This phenomenon not only causes physical and psychological discomfort, but is also fraught with the occurrence of various diseases. When surgical intervention is not possible, a special device is called upon to solve the problem - a gynecological ring (pessary). The article describes the indications, effect, advantages and disadvantages of this prolapse treatment method.

Device characteristic

A pessary is a silicone or latex ring that is worn around the cervix to keep it in position. The material of the device is hypoallergenic and safe for health. The pessary is flexible enough to fit into the vagina without discomfort. This device acts as a support for the uterus, which does not allow the organ to move into an unnatural position. A properly selected ring will help restore the previous rhythm of life and normalize the processes occurring in the body.

Pessaries vary depending on the stages of uterine prolapse, anatomical nuances, and the presence of concomitant problems with urination. In medical practice, the following types of devices are used:

1. Thin and thick rings They are used for mild to moderate degrees of prolapse, when the neck is lowered below the narrow part of the pelvis, but does not show out, and also in cases where there is a change in the position of the vaginal walls. Rings are produced with a diameter of 50 to 100 mm in increments of 5 mm.
2. Cup pessary (perforated). It is used in mild to moderate stages of uterine prolapse. It has the shape of a bowl with a hole inside with an outer diameter of 50 to 95 mm with a difference of 5 mm each. The perforated pessary additionally contains small holes.
3. Urethral. In addition to prolapse of the uterus, it is also used in the presence of problems with uncontrolled urination. It is shaped like a ring with an outward bulge that provides support for the urethra, with a diameter of 45 to 100 mm in 5 mm increments.
4. Cup-urethral. Combines the elements of the two previous types. Available in diameters from 55 to 90 mm. Designed to fix the uterus with mild or moderate prolapse and control urination.
5. Pessary Hodge. Presented in the form of an irregularly shaped ring, it can take a different position. This type is used to treat severe stages of prolapse, in cases of certain anatomical features of the structure of internal organs, when it is not advisable to install standard types of pessaries. The size of the Hodge ring varies from 55 to 95 mm.
6. Cervical perforated. It looks like a bowl with a large hole in the center and small holes around the perimeter. It is used for moderate severity of prolapse, as well as to maintain pregnancy in women with a short neck length.
7. Cubic and cubic perforated. Designed for use in severe stages of prolapse. You can only wear them for 6-12 hours. The device is made in the form of a regular hexagon with concave sides and rounded corners. Contains a thread for easy removal from the vagina. Dimensions can be in the range from 25 to 45 mm. The perforated type contains holes for excretion.
8. Mushroom pessary. It looks like a mushroom on a stalk, which has a thickening at the bottom, which helps to keep the ring in the vagina. The use of this type is carried out in the absence of the ability to install standard pessaries in severe stages of uterine prolapse. Wearing such a device is allowed for a short time (6-12 hours). It should be taken out at night. The diameter varies from 50 to 90 mm.