What Is A Pessary And Do I Need One?

What Is A Pessary And Do I Need One?

If you have incontinence, or a pelvic organ prolapse, you’ve likely heard the term “pessary” tossed around at some point.  Pelvic organ prolapse is a condition in which your pelvic floor becomes weak or compromised – sometimes due to age, sometimes due to trauma (like childbirth), causing one or more of your pelvic organs to collapse into the vagina. Pelvic organ prolapse can be mild, or severe, and symptoms can vary greatly depending on the severity. Some women may not even realize they have a prolapse until later in life.  Symptoms can include pressure or a feeling of heaviness in the vagina, incontinence, or even pain.

While some women can see big improvements in their condition with physical therapy, the condition cannot truly be “fixed” without surgery.  But, it is possible to manage pelvic organ prolapse by using a pessary. 

A pessary is a medical device, typically made out of silicone that is placed in the vagina and is used to support the pelvic floor, and the bladder, uterus and rectum.  Pessaries are not a one-size-fits all type of device. Everyone is different so your doctor will usually fit you for one that works for you. This may take a few tries, so don’t get discouraged if the first one you try doesn’t feel quite right.  Just be open with your doctor and work with them until you get the right fit.

Once you’ve found the right fit, your doctor will train you on how to insert and remove the device.  You’ll also learn how to care for your pessary, which will require weekly or biweekly cleansing.   

Pessaries can be a great solution for women with pelvic organ prolapse, or bladder incontinence, who don’t want to consider surgery (or are not quite ready for surgery yet).  It works by “holding up” the organs that may have collapsed into the vagina, relieving many of the side effects of a prolapse, such as the feeling of pressure or heaviness in the vagina, or incontinence.   

If you think you may be a good candidate for a pessary, talk to your doctor. They can review the pros and cons and help get you fitted for one.  It’s a great option for those experiencing symptoms of pelvic organ prolapse, and can provide great relief without undergoing surgery.

 

Why A Healthy Pelvic Floor Is Important

Why A Healthy Pelvic Floor Is Important

Why A Healthy Pelvic Floor Is Important

Why The Pelvic Floor Is Important

If you follow along with NAFC on a regular basis, you know how much importance we place on maintaining a strong and healthy pelvic floor. It’s a vital part of maintaining continence, alleviating symptoms of pelvic organ prolapse, and even reducing lower back pain. And don’t get us started on the benefits a strong pelvic floor has on sexual intercourse. It’s no wonder we focus so much on this magic group of muscles!

The pelvic floor is essentially a web of muscles that acts kind of like a basket holding up some pretty vital organs: the bladder, bowel and uterus.  When these muscles become weakened – from things like childbirth, heavy lifting, chronic coughing; basically anything that puts a lot of pressure on it - it can cause a loss of bladder or bowel control and can increase the risk of prolapse.  Weak pelvic floor muscles can also put strain on other muscles (the pelvic floor is connected to many other muscles in the body!) causing them to work overtime to make up for the lack of support in the pelvic floor. This imbalance can cause pain in other areas of the body too (lower back pain or hip pain for instance).

For these reasons, it’s important to make sure you’re incorporating pelvic floor and core exercises into your workouts each day. And don’t worry – the workouts don’t have to be long or strenuous. But just like every other muscle in the body, they need attention in order to maintain the strength needed to function properly. 

So, how do you get a strong pelvic floor? Some simple, daily exercises are all you need. We’ve teamed up with the folks at Carin to help you get started. Read below for information to how NAFC readers can get a free Carin Wearable Set

What is Carin?

Carin’s smart underwear is a new way to not only measure and manage leaks, but also to improve your pelvic floor strength so that you can get on with your life and eliminate those pesky leaks all together. It’s the only wearable pelvic floor exerciser on the market – painless, noninvasive, and high-tech. 

Carin Smart Underwear Set

Carin Smart Underwear Set

What’s Included in the Carin Smart Underwear Set?

Carin comes complete with a unique pair of highly absorbent underwear that can manage any leaks you may have. The set also comes with a sensor that snaps in the underwear, detects your body movement and monitors leakage. Finally, the Carin app helps you track your leaks and also sets you up on a daily workout plan to help you get stronger and manage leaks.

Carin Sensor

Carin Sensor

Carin App

Carin App

How Does It Work?

The Carin exercise program contains two parts: a weekly measuring routine and a daily exercise routine. The Carin smart underwear is worn for at least 24 hrs. with the sensor snapped in. This is the ‘measuring day’. The sensor will detect the body’s movements and track any leakage that might occur. Based on leakage, the app will then begin to recommend specific exercise routines to help you strengthen your pelvic floor in an effort to reduce leaks. There is a weekly plan of video exercises ready for you to do for 10 minutes each day. 

After the second time of wearing the smart underwear, an intelligent algorithm calculates progress made within the Carin app. The app shows the impact of exercise by counting the reduction of leaks.  80% of women using Carin have reported seeing progress between 20% to 100% in as little as 4 weeks!

 


See Carin In Action

Want a sneak peak of what to expect with Carin? Watch the video below!

Life After Leaving The Closet

Six months ago I announced that I was ‘coming out of the closet’ regarding my health issue with Pelvic Organ Prolapse. Today I’m back to share how that decision has improved my life.

After dealing with POP symptoms for what seemed like an eternity, I finally decided to seek answers to my questions concerning this health condition. It took a fair amount of courage to face the fact that I needed help. It wasn’t an easy decision by any means because I tried to tell myself it was just part of the aging process and I would just have to ‘deal with it’ the best I could.

I’m here to tell you, that isn’t the case. No woman needs to suffer in silence or hide their health issues in a closet. I totally understand how reluctant some women are to talk about or be treated for this health issue. I grew up in the era when women’s health issues weren’t openly discussed among peers, but were generally relegated to a dark closet. However, times have changed and although some may not know it, there is hope and help for those who suffer with this malady. New treatment options occur on a daily basis that allows women to control, improve and repair this cryptic health condition. It’s time to openly discuss women’s health issues.

Although I tried to keep up with a daily exercise program prior to surgery, it became difficult because of the pressure and pain I was experiencing. Because of this I gained an extra 15 pounds in a very short period of time. It was a very depressing time for me. But, after the brief recovery from surgery in January I was once again able to exercise and follow a simple diet that resulted in my losing 22 pounds by mid-March.

My life today is one-hundred percent better than it was prior to my surgery. I can go for walks, out to dinner, and shopping without having to worry about what might happen.  If you suffer from Pelvic Organ Prolapse I encourage you to not hide in a closet or allow it define how you live your life. Take charge of your health. After all, there is a better life after leaving the closet!

Betty Heath

Did you miss Betty's original article about her surgery? Read it here!


betty+heath.jpg

About The Author:  Betty Heath lives in Colorado with her husband. She is “retired from work, but not from living”, and has a weekly column called “As I See It”, which appears each Sunday in the Longmont Times-Call, owned by the Denver Post. She enjoys writing, cooking, gardening, and quilting. Betty also volunteers in the St. Vrain Valley School District, helping students learn how to write from their heart. For the past six years, she and her husband have volunteered as Santa and Mrs. Claus for the Holiday Festival in the Carbon Valley. You can read more from Betty at her blog, The Rejoicing Soul.

Coming Out Of The Closet About Pelvic Organ Prolapse

This is a guest post from Betty Heath, of The Rejoicing Soul.

During the past twelve years I have shared much of my life’s journey with you. Well, today I am coming out of the closet.  Stunning isn’t it? I was recently diagnosed with Pelvic Organ Prolapse. How many of you can identify with me? The current estimate of the number of women in the U.S. with this condition is approximately 4.3 million. According to a recent study by the World Health Organization guestimates indicate that there are 36 million women world-wide with this condition. The reality is that it is difficult to know what the real numbers are because women are reluctant to be talk about it or be treated for it.

Pelvic Organ Prolapse (POP) is quite common among today’s female population. Many women have the symptoms but because they are embarrassed to discuss them with anyone they suffer in silence.  POP can occur when the pelvic floor muscles weaken and one or more organs shift out into the vaginal canal and even bulge outside of the body.

My journey with POP began sometime in the spring of 2016. I began having symptoms of POP which include pressure, pain and/or fullness in vagina or rectum or both; sensation of ‘your insides falling out’; bulging in the vagina; severe back pain and incontinence. Every time I went for a walk or even sneezed I thought my insides were going to fall right out onto the ground. I began staying home more often and said little about it to my friends. At first I attributed these symptoms to old age and laughed them off. After all, I am approaching the ripe old age of 80. We hear and see so many TV ads regarding incontinence and because the causes are never addressed we become oblivious to what they might be.

This past fall I finally decided I didn’t want to spend the rest of my life worrying about my insides falling out and was tired of dealing with this issue so I made an appointment with a gynecologist. After the initial exam I was referred to Dr. Alexander Shapiro who is a specialist gyn/urologist in Denver. That exam took place in early December and was one hour and thirty minutes.

After the exam I told him I never dreamed I would be sitting in a gyn/urologist office at the age of 79. He smiled and replied, “We do have ways to keep popping up in your lives, don’t we.”  I then told him this was the most disgusting, gross thing that has ever happened to me. He said, “Right now your insides are a total mess. This is a very intimate surgery and is a major surgery. This is who you are right now and you can’t allow this to define your life. I promise you I can repair the damage and relieve the pain and discomfort”.

The four-hour surgery took place on Monday, January 30. I told my physician that most women my age are having face lifts and here I was having a butt-lift. I went home Tuesday and Wednesday as I was having breakfast I suddenly realized that the fullness/pressure feeling and the back pain I had prior to surgery were totally gone. Oh, what a relief it is. I cried tears of joy. I’ve experienced minimal pain with this surgery.

Today, if you are a woman reading this (or a man who has a woman in your life with this condition) I urge you to make an appointment to at least talk with your physician about your problem. There is help and hope for women with POP. New treatment options evolve daily to control, improve and repair this cryptic health condition.

Join with me in taking Pelvic Organ Prolapse out of the closet and make it common knowledge for women of all ages. Don’t allow this condition to define who you are or how you live your life.  Don’t wait! Call for your appointment today.

Betty Heath
Betty Heath

About The Author:  Betty Heath lives in Colorado with her husband. She is “retired from work, but not from living”, and has a weekly column called “As I See It”, which appears each Sunday in the Longmont Times-Call, owned by the Denver Post. She enjoys writing, cooking, gardening, and quilting. Betty also volunteers in the St. Vrain Valley School District, helping students learn how to write from their heart. For the past six years, she and her husband have volunteered as Santa and Mrs. Claus for the Holiday Festival in the Carbon Valley. You can read more from Betty at her blog, The Rejoicing Soul.

Prolapse After Pregnancy – It’s Not Your Fault.

Prolapse After Pregnancy - It's Not Your Fault.

Around 6 weeks postpartum, I had expected to feel a bit more like myself.  I had avoided exploring anything in the vaginal area for fear of what I would find, but had felt a general heaviness since I had given birth.  Not knowing for sure if this was normal, I made an appointment with my doctor to get checked out. 

Upon examination, my doctor confirmed that I had a prolapsed bladder.  His tone was nonchalant, as if it was totally normal and something that just happened sometimes. 

I was completely shocked. What had gone wrong?  And why did I never hear that this was a possibility?  I immediately started blaming myself.  Why had I not done more kegels during my pregnancy?  Why didn’t I do more research to know that something like this could happen?  Did the decision to use a vacuum during the last bit of pushing influence this?  What could I have done to prevent this?

But the truth is, some women really are just more susceptible to prolapse.  While a prolapse can occur for many reasons, some women have more of a genetic risk for the condition due to the strength of the connective tissues.  It’s not your fault. 

That being said, there are some things that may help you either avoid a prolapse, or at least improve your symptoms if you have one.

How to improve symptoms of pelvic organ prolapse

  • Maintain a normal weight.  If you are overweight, you are more susceptible to a prolapse due to increased pressure inside the abdomen. 
  • Avoid constipation.  Becoming constipated can cause you to strain during bowel movements, increasing the chance of a prolapse.  Ensure you are eating a high fiber diet and drink plenty of water every day.
  • Keep active.  A regular exercise plan keeps your weight in check, and also helps promote healthy bowels.  Be sure to include your pelvic muscles in your daily workout routine too.
  • Avoid extra pressure inside the abdomen.  Things like lifting heavy objects, and chronic coughing, create persistent pressure, which can increase the likelihood of developing a prolapse, or making your symptoms worse if you have one.  Stay healthy and avoid strenuous lifting. 

Whatever you do though, don’t blame yourself for developing a prolapse.  Instead, use that energy to find out what you can do to improve your symptoms and treat the condition.  Talk to your doctor about your options, and find a qualified physical therapist to help you learn how to strengthen your muscles to improve symptoms.

What To Expect After Pelvic Floor Reconstruction

What to expect after pelvic floor reconstruction surgery for pelvic organ prolapse

The decision to undergo pelvic reconstructive surgery to correct pelvic organ prolapse (POP) can be difficult. Women often wait years dealing with symptoms of POP before they commit to surgery. Aside from decreasing symptoms of prolapse, a desired outcome of pelvic floor reconstruction is for the woman to be able to return to her active life. Likely, the surgeon has provided some information about do’s and don’ts, but this is usually related to immediately post-surgery.  Most pelvic floor surgeries require an initial 6 to 8 week rest period —keeping activity very light—no sexual intercourse, no heavy lifting, no running etc.

But after the initial rest period, then what? Are there activities to avoid or limit? How much is “too much” to lift?  Should anything be avoided altogether? Medical literature tells us that 30% of women may require a second surgery at some point in the future due to failure of the first or because of another pelvic problem.1 Yet, there is little information on improving outcomes in order to prevent another surgery. Most surgeons use a common-sense approach in advising their patients, and if a woman has specific questions or concerns, she is always advised to ask her surgeon. The surgeon has the best understanding of how the procedure went and in what shape the woman’s pelvic tissues are.

The primary cause of POP is trauma to the pelvic floor muscles (PFM,) connective tissue or “fascia” and ligaments. These structures become unable to support the pelvic organs. The majority of women undergoing surgery sustain tissue injury from childbirth trauma.  More rarely, women may develop severe prolapse due to extreme increases in intra-abdominal pressure (IAP) for other reasons.  Examples include illnesses that cause chronic coughing or performing frequent Valsalva maneuvers (straining) such as with chronic constipation.

In attempting to identify risk factors and make post-surgical recommendations, research has determined that indeed, the two things that increase IAP and vaginal pressure (VP) the most are coughing and Valsalva maneuvers. Most of these studies compared pressure measurements during everyday activities like supine lying, standing, lifting, running, coughing and straining. According to the research, many things increase IAP; just getting out of bed will mildly increase IAP, as will lifting moderate weight and running. One study went so far as to say that many post-surgical guidelines are “needlessly restrictive.”5 The researchers found that in subjects without pelvic floor problems tasks such as lifting eight to 20 pounds off a counter, lifting 13 pounds from the floor, walking briskly, performing crunches all produced no more increase in IAP than getting out of a chair. They summarized that “how lifting is done impacts intra-abdominal pressure.” The good news is, that the research, found that unless a woman has a chronic cough condition or habitually performs Valsalva maneuvers, everyday stressors like standing, walking, lifting normal weight, sexual intercourse and running should be okay post pelvic surgery.

Women seen by a specially trained pelvic physical therapist (PT) after surgery are taught strengthening exercises and postural strategies, as well as how to lift correctly. If risk factors are present the woman may need extra help to learn how to care for her pelvic floor during stressful activities, this may include diet counseling and information on sexual positions to limit stress to the PFM.

Here is a list of some things PT’s might teach their patients post surgery:

Posture

PFM works best when the spine, pelvis and hips are in good alignment. If a woman’s back is too rounded, the normal bony structure of the pelvis can’t act to support the pelvic organs as intended. If the back is too arched, the pelvic muscles can become overstretched and strained. Normal spinal posture is a simple and effective way to support the pelvic organs. Learn how to maintain good posture with your normal daily activities, such as sitting at a computer, lifting, squatting etc.

Diet

To avoid constipation and straining (Valsalva) with bowel movements, drink plenty of water, eat a balanced, healthy diet with whole grains and fresh vegetables and learn about soluble and insoluble fiber. If constipation exists, it needs to be assessed to determine the type of constipation, and then be properly treated.Toilet Posture: We know that the vast majority of people evacuate their bowels best when in a squatting position. Most modern toilets don’t accommodate for this. Try placing a phone book or two under the feet to elevate the legs. Or try this device, which allows for a nice squatting position when on the toilet:  spine in neutral, but hips flexed and knees above the hips.

Restful Rescue Poses

There are excellent resting positions that utilize gravity to encourage organs to “reposition” back into the pelvic cavity. Here’s one: lie on your back and place a pillow or small wedge under the pelvis to invert your pelvic region. Place pillows under your knees as well and one pillow (or none) under the head. It’s a lovely position to rest in, and for those doing a strengthening program, it’s a great position for that too. If you want to go all out, place a heating pad over your tummy, turn the lights low, play soothing music and rest for a blissful 20 minutes or so. 

Biomechanical Considerations for Sexual Intercourse

Let’s face it, the majority of women going through POP surgery are sexually active. Sex must be addressed and often it’s the PT who spends the time with the patient and can make the best recommendations. For example, if a woman has pain with vaginal penetration, she may need to perform special stretching exercises to open the vaginal introitus and the PT can advise on intercourse positions that will least stress the PFM. Menopausal women may also need to discuss additional local estrogen and lubricant with your surgeon or physical therapist.

Pelvic Bracing

This is a technique of co-contracting one’s lower abdominal muscles, deep back stabilizing muscles, with the PFM. When done correctly it can limit the stress on the pelvic organs during activities of increased IAP, like lifting or squatting. It sounds complicated but it’s really not. Women should learn to do this in any position. First, attend to your PFM by giving them a gentle squeeze (feel the perineum lift) followed immediately by a relaxation (feel the perineum release down.) Starting from a relaxed place, gently draw the PFM upward as you gently draw the navel inward. Imagine you are trying to lift your vagina like an elevator as you feel your lower tummy gently flatten. Do this gently, not full force. You should be able to breathe normally as you do this. You’ll feel the two muscle groups acting together to tighten the lower belly and “brace” the pelvic floor. The deep back muscles should activate when you do this providing posterior support simultaneously. Hold this co-contraction for a few seconds then release. If you have trouble with this, seek out a pelvic floor PT in your area to help you learn. Learning how to brace during functional activities sometimes requires a bit of training, so again, seeking a specialist may be indicated if you are someone who has risk factors.

Pelvic Floor Muscle (PFM) Strengthening.

Often called “Kegels,” PFM strengthening involves exercising the PFM by contracting them for short or long periods of time—usually from two to four seconds to train the “fast twitch” muscle fibers, and five to 30 seconds to train the “slow twitch” muscle fibers.  Sometimes these exercises are done in conjunction with other muscle groups. The muscle fibers of the pelvic floor are 70% slow twitch and only 30% fast twitch. This means that the PFM are much better at endurance events than brute strength activities. They act more as supportive postural muscles; however we occasionally need a quick strong contraction to avoid leaking with a sneeze. Correct PFM strengthening incorporates exercises for both types of muscle.

Some women actually do too much exercise and develop tight, painful muscles. Sometimes, after a pelvic surgery, a woman might actually feel “tight” or “tense” inside. This is from the surgery, not because the muscles magically strengthened from the procedure. If after surgery you have symptoms of pain (either at rest or with an activity like sex), urinary urgency or frequency, then tell your doctor. Kegels would not be appropriate for you. If this is the case be sure to talk to your doctor for other options, such as biofeedback.

Other women need to exercise to develop more muscle tone and strength. The trick is to ensure there is balance between strength and flexibility. If you are still leaking or feel weak, then strengthening may be helpful.

Physical therapists with a pelvic floor specialization are trained to assess the whole person to determine an appropriate exercise routine, and women are advised to be evaluated before undertaking a rigorous strength program.

ASK THE EXPERT: Is It Safe To Have Sex With A Vaginal Prolapse?

Is it Safe To Have Sex With A Vaginal Prolapse?

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: Is it safe to have sex if you have a vaginal prolapse?

Answer: Yes! A prolapse occurs when a woman’s vaginal wall weakens and collapses, causing the uterus, rectum or bladder to fall into the vagina. However, in most cases, it is completely fine to have sex as long as the woman feels comfortable.  And, having sex when you have a prolapse will not cause any harm to the bladder, rectum or uterus, nor will it make the prolapse worse.

Some women with a prolapsed organ may feel some slight discomfort during sex. Using lubricant can help, as well as ensuring your pelvic floor is completely relaxed before you begin. Trying other positions may also alleviate any pain you are experiencing too. Talk with your partner about what feels best for you.

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Contact us!

What Is Bladder Prolapse And Why Does It Happen?

What Is Bladder Prolapse?

Bladder prolapse is when your bladder is no longer being held up in its appropriate location in your body by the muscles around it. For some women, bladder prolapse can feel like a heaviness above their vagina, and for others, the bladder is actually resting or ‘leaning’ on the vagina. The condition can be very mild (some women may not even realize they have it), or they can be very severe. If left untreated, many women may see an increase in symptoms such as incontinence or pain as they get older.

Prolapse can occur for many different reasons. The most prevalent is in direct result of pregnancy and childbirth. During pregnancy and childbirth, the women’s organs are shifted around in their abdomen and are often pushed to make room for the baby.  The pelvic floor, which typically holds up those organs, is now helping keep a growing baby hoisted healthfully above the pelvic bones and the reproductive organs. Childbirth exacerbates the pressure and trauma those organs and the pelvic floor withstand because of the sheer force needed to birth a child. This all results in the pelvic floor being very weak and overworked.

When the floor can’t withstand any more weight and pressure, the organs it supports begin to prolapse.

There are many options for treating a prolapse. Physical Therapy can do wonders for women with this condition. In addition, management tools, such as pessaries, can help ease many of the physical symptoms of pelvic organ prolapse. And, if none of these options do the trick for you, there are surgical procedures that can help correct the issue (read about this woman's journey to healing her pelvic organ prolapse.)

If you think you may be experiencing this and want to learn more, go here for more detailed explanation and suggested treatment options

Pessaries And Non-Surgical Options For Prolapse Treatment

Pessaries and Non-surgical options for prolapse treatment

I always wanted a large family.  After giving birth to and raising 4 children, I think I’ve pretty much fulfilled that dream.  My family is everything that I expected it would be.  What I never expected, however, was to have a prolapsed bladder.

I discovered it when I turned 63.  I had a feeling of heaviness “down there” for a while, but didn’t really think anything of it. I experienced a few accidents in the months before my birthday but thought they were just that – accidents. I was wrong. I went to the doctor for my usual check up, tried to explain what I was experiencing, and he told me I may have a prolapse. Prolapse is when the muscles supporting your bladder, rectum and uterus weaken. This weakening can cause your organs to fall into or through the opening of the vagina. This can happen to any woman with or without vaginal childbirth, but women who have had strain on their vaginal muscles (ahem, birthing 4 children) are at greater risk. After an examination, my doctor diagnosed me with a cystocele, or a prolapsed bladder.

At first I was horrified – the thought of an organ protruding, even slightly, sounded appalling.  What would this mean?  How would it affect my day-to-day life? Would things progress to a level greater than what I was already experiencing? ? 

Luckily for me, my prolapse is mild.  My doctor told me that as long as my symptoms were not causing me much harm, surgery was likely not necessary.  Some pelvic organ prolapse (POP) will improve on its own through watchful waiting, although my doctor said it is not possible to identify whose POP will improve with time. A common treatment option for those who do not want or need surgery is a pessary.

Pessaries are silicon devices that come in a variety of shapes and sizes and are placed in the vagina to provide support to the pelvic organs. Because each woman is different, the pessaries need to be fitted to the individual.  I decided to give it a try and was fitted three different times before the final size was decided.  I’ve had it in for 3 months so far and it is comfortable and seems to be treating the feeling of heaviness I had been experiencing very well.  It does require some upkeep and needs to be removed and cleaned on a regular basis, however this is easy to do and even if you have trouble, you can have the pessary removed and regularly cleaned by your provider. 

In addition to my pessary, my doctor also prescribed a vaginal estrogen.  This helps lubricate the area and reduce the risk of irritation or ulceration.  It also reduces the risk of getting a urinary tract infection.

Never in a million years did I think this would happen to me – I didn’t even really know it was possible to be honest. But thanks to my pessary, I’m able to easily manage my symptoms and live my life the way I want to.