How to use the uterine ring correctly. Pessary for uterine prolapse - treatment of prolapse without surgery. Features of device installation

Uterine rings are a simple, convenient and absolutely safe way to treat uterine prolapse. Due to their versatility, pessaries make it possible to very effectively, without the use of radical measures, solve a woman’s specific gynecological problems.

Being a strong smooth muscle organ, the uterus can sometimes change its position in the pelvic cavity and shift to the vagina or external genitalia. In this case, prolapse or prolapse of an organ occurs, which partially or completely comes out, causing the woman a lot of inconvenience. The most common complaints in such cases are nagging pain of varying intensity in the lower back, lower abdomen and sacrum, a sensation of a foreign body in the perineum, as well as great discomfort during normal hygiene procedures or during sexual intercourse.

There are four stages of prolapse:

I - slight downward displacement of the uterus;
II - initial prolapse, when, upon straining, the cervix appears from the genital slit;
III - partial prolapse - part of the body of the uterus protrudes from the vagina already at rest;
IV - complete loss.

Treatment is selected according to the type and severity of organ prolapse. However, the best therapeutic and alternative method, known to Hippocrates, for “reducing” the uterus is special uterine rings.

Main types, shapes and sizes of pessaries

Pessaries or uterine rings are flexible silicone medical products that are designed to create additional support, fix the organ when it is displaced, and also as a barrier to prevent prolapse of the uterus, rectum, bladder or sagging of the vaginal walls. Due to its elasticity, this device, after being inserted inside, easily takes the desired position and does not at all affect the woman’s freedom of movement and her usual rhythm of life.

Rings vary in shape and size:

thin;
curved (Hodge pessaries);
mushroom-shaped;
cup regular or perforated;
tandem;
urethral;
calyx-urethral;
cubic;
adaptive.

The diameters of the pessaries are also uneven and vary from a minimum of 50 mm to a maximum of 100 mm. Moreover, according to the type of appointment they distinguish:

Obstetric rings. Indicated for pregnant women to avoid the threat of premature birth and for the prevention of ICI (isthmic-cervical insufficiency).
Gynecological rings. Used for prolapse/prolapse of the uterus and organs of the female reproductive system.

Determining and selecting the desired type and size of pessary is exclusively a medical prerogative.

However, it is important to distinguish between vaginal and uterine rings. The former act as a barrier method of contraception, while uterine rings are a therapeutic and prophylactic device. You can buy the necessary pessary in pharmacies or medical equipment stores, but only after consulting a gynecologist.

Advantages:

Effective therapy for uterine prolapse.
Help in maintaining pregnancy and preventing the risk of premature birth.
High effectiveness at any stage of pregnancy and with varying degrees of uterine prolapse.
Hypoallergenic.
Safety and ease of use.
There is absolutely no risk of soft tissue injury.
A good alternative to surgical treatment (various types of operations are discussed at the link).

Flaws:

Installation of a pessary

The primary insertion of the uterine ring is carried out exclusively by a gynecologist in an outpatient setting. In the future, the woman, with the help of simple manipulations, can carry out this procedure independently. Its installation is always preceded by an individual examination for infectious and bacteriological inflammation. Before direct insertion of the uterine ring, it is sterilized by boiling or rinsing in hot water. For smooth and easier installation, the device is treated with vegetable oil or sterile petroleum jelly.

The pessary is always inserted in the supine position. During this process, the ring is compressed and inserted deep into the vagina so that, when unrolled, the convex surface of the pessary faces the cervix. During and after this procedure, provided that the shape and size of the ring is selected correctly, the woman should not experience any painful or uncomfortable sensations.

In this video you can see the technique for introducing one type of pessary:

Further, every two weeks for 1.5 months, an examination by a gynecologist is required to ensure the normal position of the device and the absence of the development of possible associated complications. The average period of wearing the ring is from 2 to 6 months, depending on the history of prolapse. If the pessary is not intended to be worn continuously, it must be treated with an antiseptic before each subsequent insertion.

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Content

Uterine prolapse is a fairly common disease, appearing most often in women aged 45-50 years. It occurs due to weakening of the muscles of the abdominal wall and pelvis, which are involved in maintaining the uterus and appendages. Prolapse can occur as a result of numerous infectious inflammations, severe and multiple births.

To eliminate this problem, specialized gynecological rings or pessaries are widely used in medical practice.

Characteristics and types of gynecological rings

A gynecological ring is a device inserted into the vaginal cavity. It creates a kind of support and support for the normal position of the uterus. Most often, rings are made of silicone or latex. It is these materials that provide high elasticity, strength and safety of pessaries.

In addition to gynecological rings, there are obstetric rings. They are intended to prevent premature birth and prevent the development of isthmic-cervical insufficiency. In addition, a distinction is made between vaginal and uterine rings. The former are used as a method of contraception, and the latter for the treatment and prevention of a number of diseases.

Rings used for uterine prolapse come in several types. First of all, they are classified according to their shape:

thin;
curved;
cup - used in the initial and middle stages of prolapse, have a hole for the release of secretions;
cubic - used in severe stages of pathology, and can be used for no more than 12 hours;
mushroom - used rarely and only for severe forms of uterine prolapse;
tandem - consist of two silicone elements, designed to eliminate 3-4 degrees of prolapse;
caliceal-urethral - indicated for mild prolapse, accompanied by urinary incontinence.

Depending on the individual characteristics and size of the vaginal cavity and the doctor selects the most suitable diameter of the device. The minimum size is 50 mm and the maximum is 100 mm.

The advantages of these devices include:

visible effect: gradually the uterus returns to its normal position;
allow you to maintain pregnancy;
prevent premature birth;
do not cause allergies;
quite simple and easy to use;
do not interfere with the usual way of life;
do not injure the walls of the vagina and cervix.

Despite all the above advantages, the pessary, if used incorrectly, can cause discomfort in a woman, lead to the development of bacterial vaginosis, and also compress the organs of the genitourinary system.

A gynecological ring, or pessary, is of great importance in the treatment of uterine prolapse. In this condition, the body becomes very vulnerable to pathogens and viruses, and displacement of the urethra can occur, leading to urinary incontinence. Prolapse of the uterus leads to poor circulation, which will affect the condition of all pelvic organs. That is why, to prevent all these problems, gynecologists prescribe the installation of a pessary.

Contraindications and indications

The main indications for installing a gynecological ring, in addition to uterine prolapse, are:

prevention of the reproductive system before surgery;
urinary incontinence due to urethral displacement;
monitoring the results of the operation;
maintaining pregnancy;
preventing premature birth;
impossibility or refusal to perform surgical intervention.

The disadvantages of using a ring for uterine prolapse include individual intolerance and an allergic reaction to the latex or silicone from which the pessary is made. Restrictions also include:

congenital pathologies or abnormalities of the reproductive system;
cervical erosion;
inflammatory processes;
heavy bleeding;
inflammation caused by infection;
cervical neoplasms of various types.

Only a doctor should prescribe the installation of a gynecological ring, as well as select the required size, type and diameter of this device.

Installation of a pessary

Correct installation of the gynecological ring during uterine prolapse ensures the absence of any discomfort in everyday life and during physical activity. That is why the first introduction of this device should only occur by a doctor.

There are stages of installation of a gynecological ring that prevents uterine prolapse.

Before directly inserting the pessary into the vagina, the device must be thoroughly washed with soap if it is not in its sterile original packaging. The product is then sterilized.
For easier and more convenient installation, it is recommended to lubricate the pessary with vaginal cream. This will make it easier for the ring to slide in.
It is necessary to return the uterus to its original normal position, which will subsequently be fixed by the gynecological ring. The first few times it is best to do this with a doctor.
If a woman has already received permission to put a ring on herself at home, then the following plan should be followed: take the ring in one hand, squeeze it and in this position insert it into the vaginal cavity. After it comes into contact with the cervix, it must be straightened. Make sure that the ring does not cause discomfort or pain or put pressure on the neck or bladder. This completes the installation of the pessary.

All types of rings, except mushroom and cubic, can be worn for 30-40 days. At first, you need to undergo a gynecological examination every 1.5-2 weeks, then visit a doctor a month later. After the body gets used to it, consultation and examination are carried out every three months. This allows you to assess the condition of the mucous membranes and the position of organs in the pelvis.

Any discomfort, urinary incontinence or pain during physical activity should be accompanied by consultation with a gynecologist.

A gynecological ring is a fairly effective and safe device for eliminating uterine prolapse. It does not cause discomfort in everyday life, does not restrict a woman’s movement, and in most cases does not cause an allergic reaction from the body.

The network of muscles, ligaments and fascia around the vagina, cervix, uterus and adjacent organs is a complex structure that holds the pelvic organs in a normal position so that they maintain their mobility during sex, urination, defecation, pregnancy and childbirth. Various components of this support system can be compromised by trauma and prolonged exposure to increased intra-abdominal pressure, which can ultimately lead to pelvic organ prolapse.

Prolapse (drooping) of the pelvic organs is a condition in which organs such as the uterus, rectum, bladder, urethra, small intestine or vagina itself may begin to deviate from their normal position towards the exit of the vagina until they completely fall out (Fig. 1 ).

Rice. 1. Pelvic organ prolapse: prolapsed uterus, anterior vaginal wall with part of the bladder, posterior vaginal wall with part of the rectum.

Symptoms that arise as a result pelvic organ prolapse usually affect sexual function and lead to problems with emission and defecation. In addition, women experience a feeling of discomfort, pain, and protrusion from the genital opening. All this is often accompanied by significant psycho-emotional disorders.

What are the types of pelvic organ prolapse:

Rectocele(rectal prolapse). This type of prolapse involves the prolapse of the back wall of the vagina (rectovaginal fascia). When this fascia weakens, the wall of the rectum presses against the wall of the vagina, creating a bulge. This thickening may become especially noticeable during bowel movements (Figure 1).
Cystocele(bladder prolapse). This can happen when the front wall of the vagina (pubocervical fascia) becomes torn (usually as a result of childbirth). The bladder puts pressure on the weakened anterior vaginal wall and causes prolapse (Fig. 1). This is often accompanied by prolapse of the urethra ( urethrocele). Sometimes, when there is a defect in the pubocervical fascia located under the urethra (suburethral ligament), hypermobility (pathological mobility) of the urethra occurs, which leads to (urine leakage during coughing, sneezing or exercise).
Enterocele(hernia of the small intestine). Weakening of the upper (apical) supporting structures of the vagina can cause this type of prolapse. Often this type of prolapse is combined with a rectocele and is called rectoenterocele (Fig. 2).

Rice. 2. Enterocele

Uterine prolapse (metrocele). Occurs due to weakening of the group of ligaments that make up the so-called pericervical ring (sacrouterine, cardinal ligaments). This leads to uterine prolapse, which is usually accompanied by prolapse of both the anterior and posterior vaginal walls (Fig. 1).
Prolapse of the vaginal vault (apical prolapse). Is an option enterocele which occurs after (hysterectomy). Since the uterus provides support for the upper part of the vagina, this operation results in some degree of apical prolapse. In severe cases, the vagina seems to turn inside out and protrudes from the genital slit by 10 centimeters or more (Fig. 3).

Rice. 3. Apical prolapse after hysterectomy

What are the grades of pelvic organ prolapse?

There are a huge number of classifications of pelvic organ prolapse. But, in clinical practice, we more often use the simple classification presented below (Fig. 4).

Zero degree of prolapse: the uterus is located within the upper third of the vagina.
First degree prolapse: the uterus is located within the middle third of the vagina.
Second degree of prolapse: the uterus reaches the exit from the genital slit.
Third degree prolapse: the uterus protrudes beyond the genital opening, but not 100%.
Fourth degree prolapse: the entire uterus is outside the vagina. This degree is also called procidentia, or complete prolapse of the uterus.

Rice. 4. Classification of genital prolapse (according to Baden-Walker)

For scientific purposes, among specialists - urogynecologists, more complex but accurate classifications, for example, POP-Q, are certainly common.

Approximately 30-40% of women will have some degree of pelvic organ prolapse during their lifetime, usually after menopause, childbirth or hysterectomy. For most women, symptoms of prolapse begin after age 40 and progress more quickly after menopause. Many women with prolapse symptoms do not seek medical help due to embarrassment or other reasons. Some women who have pelvic organ prolapse do not experience any symptoms.

Treatment of pelvic organ prolapse

Undoubtedly, surgical treatment method pelvic organ prolapse, which includes many different options for operations, is the most advanced, because allows you to restore the anatomy and functionality of the genital and adjacent organs to their “original form.” However, operations have their own risks associated with anesthesia, surgical complications and relapses of the disease.

Since ancient times, the well-known and still relevant method of treating pelvic organ prolapse in women is also use of pessaries.

Historical reference

Before the modern era of operative gynecology pessaries were the only effective treatment option for women with symptoms pelvic organ prolapse. Modern gynecologists tend to be skeptical about the use of pessaries and rely mainly on surgical treatment of this pathology. There is virtually no school for teaching the use of pessaries. This attitude could not help but be passed on to patients, who often underestimate the effectiveness and safety of using pessaries for prolapse of the uterus and vaginal walls. Not the least role in this situation was played by the virtual lack, until recently, of a variety of shapes and sizes of pessaries on the Ukrainian market, as well as the methodology for their selection at an appointment with a gynecologist.

Pessaries have been an integral part of the treatment arsenal for pelvic organ prolapse in women for more than a millennium. In the literature, there are references to uterine prolapse in papyri of ancient Egypt dating back to 2000 BC. The oldest surviving medical text dealing with the treatment of genital prolapse is that of Soranus (98-138 AD). In his book “Diseases of Women,” he described methods for treating prolapse such as hanging a woman upside down for 1 day (Fig. 5).

Rice. 5. Treatment of pelvic organ prolapse by hanging upside down

The second curious method of treatment in those centuries was the use of aromatic substances orally. Doctors of that time believed that the uterus, like an animal, would return inside “smelling” a pleasant smell.

Another technique involved tying a dead rodent or lizard to the prolapsed uterus in the hopes of “scaring” the uterus into “escaping” back into the correct position.

Soranus sharply criticized these and other utopian treatments. In turn, he suggested tamponing the vagina with woolen tampons soaked in olive oil. After the uterus was reduced using such a tampon, the woman’s legs were tied together and she lay for 3 days.

After Soranus, many also proposed various options, which became the prototype of modern pessaries. One of the scientists who promoted the use of pessaries was the great French surgeon Ambroa Pare (1510-1590). Pare made oval-shaped vaginal pessaries from brass or waxed and polished wood.

The prototype of modern pessaries were the products of Hendrik Van Deventer (1651-1724), who founded use of pessaries from a scientific point of view (Fig. 6).

Rice. 6. Deventer pessaries - prototypes of modern ones

Modern stage

Today in Ukraine the possibilities have expanded significantly due to the emergence of modern pessaries of various shapes and sizes (Fig. 7). Modern silicone pessaries are designed to effectively treat various forms of genital prolapse and urinary incontinence. Pessaries have been used for many years for the conservative treatment of genital prolapse and urinary incontinence. In recent years, this treatment method has experienced a second youth. The revival of pessaries is due to the fact that modern products are made from a special material - medical silicone rubber. The use of elastic, hypoallergenic silicone has reduced the risk of complications to a minimum and created comfortable and effective types of pessaries for the patient.

Rice. 7. Variety of modern pessaries

Indications for the use of pessaries in modern gynecology:

Complicated and uncomplicated genital prolapse of varying degrees if:

the patient does not want to undergo surgery;
there are contraindications to surgical treatment (somatic pathology, age);
it is necessary to delay surgical treatment (decubital cervical ulcer, subcompensation for somatic pathology);
you need to see what effect to expect from the operation, for example, with stress urinary incontinence.

Important points:

Pessaries are intended for individual use.
The pessary is supplied non-sterile.
Disinfection is required before use.
The pessary can be washed with warm tap water and detergent.
The pessary can be sterilized by steam (134ºC/3.8 bar) or hot air (250ºC).
The properties of the material allow the product to be disinfected many times. It is not recommended to sterilize pessaries by boiling.

Some facts about modern pessaries

Older women are more likely to choose pessary treatment rather than surgery and to continue wearing the pessary after a successful experience.
Up to three quarters of patients who choose pessaries as treatment for prolapse have successful experience wearing them.
Factors that negatively affect the success of using a pessary:

recurrent prolapse after vaginal surgery
short vagina
very wide entrance to the vagina
very significant degree of omission

Patient satisfaction with the pessary is usually high, but persistence or reappearance often prompts discontinuation of its use in favor of surgery.
Pessaries in the form of a ring can be successfully used if the prolapse does not exceed degree III. With IV degree of prolapse, cubic pessaries are more suitable.
The most common complications include: vaginal abrasions (bleeding, discomfort), foul odor.
Current practice in the use of pessaries varies widely depending on the attitude of the physician.

What types of pessaries are there?

Silicone pessary "ring"

Description: the pessary has the shape of a ring and is equipped with an internal elastic element.

Silicone pessary: ring comes in the following sizes (outer diameter): 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 mm.

This pessary model is most often used to correct mild prolapse of the vaginal walls.

Silicone pessary "thick ring"

Description: silicone pessary: the ring is thick and shaped like a ring.

The product is available in the following sizes (outer diameter): 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 mm.

Silicone pessary: a thick ring is used to correct prolapse of the vaginal walls of mild to moderate severity.

Silicone cup pessary and perforated cup pessary

Description: silicone pessary: cup and silicone pessary: cup perforated has the shape of a bowl with a large central hole. In a cup pessary, perforated along the periphery, holes of a smaller diameter are made.

Silicone pessaries: cup and perforated cup are available in the following sizes (outer diameter): 55, 60, 65, 70, 75, 80, 85, 90, 95 mm.

Cup pessaries are used in cases of mild to moderate pelvic prolapse.

Silicone urethral pessary

Description: silicone pessary: the urethral one has the shape of a ring, on the rim of the ring there is an oval thickening. The thickening is intended for additional fixation of the urethra. The ring is reinforced with an elastic element.

Silicone pessary: urethral is available in the following sizes (outer diameter): 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 mm.

Urethral pessaries are used for the treatment and correction of mild cystocele.

Silicone pessary cup-urethral

Description: silicone pessary: cup-urethral has the shape of a cup with an oval thickening and a large central hole. The thickening is intended for additional fixation of the urethra.

Silicone pessary: cup-urethral are available in the following sizes (outer diameter): 55, 60, 65, 70, 75, 80, 85, 90 mm.

Urethral cup pessaries are used to correct mild to moderate pelvic prolapse in combination with.

Silicone pessary Khoja

Description: Khoja silicone pessary is a ring made of elastic, biologically inert silicone, reinforced with a deformable element.

The Khoja silicone pessary is available in the following sizes: 55, 60, 65, 70, 75, 80, 85, 90, 95 mm.

The design of the pessary allows you to give the product any shape. This allows the use of the Hodge pessary in situations where the anatomical features of the patient do not allow the use of traditional pessaries. Most often, a pessary is used for severe degrees of prolapse of the vaginal walls.

Perforated silicone cervical pessary

Description: silicone pessary: cervical perforated has the shape of a deep cup with a large central hole and numerous holes of smaller diameter along the periphery.

This pessary model is used to correct moderate vaginal wall prolapse and to prevent premature birth with a short cervix.

Silicone cubic pessary

Description: silicone pessary: cubic and silicone pessary: cubic perforated has the shape of a cube with concave sides. The perforated silicone cubic pessary model has holes on the sides for the outflow of vaginal discharge. For ease of removal, cubic pessaries are equipped with a thread.

Silicone pessary: cubic and cubic perforated, available in the following sizes: 25, 29, 32, 37, 41, 45 mm.

Cubic pessaries are used for severe prolapse. This pessary model is intended for short-term use (no more than 6-12 hours, insertion during the day and removal at night).

Silicone mushroom pessary

Description: The mushroom pessary has the shape of a bowl on a stem. There is a thickening at the base of the leg. The leg of the pessary is designed to hold it as deep as possible in the vagina.

Silicone pessary: mushroom is available in the following sizes (outer diameter): 50, 55, 60, 65, 70, 75, 80, 85, 90 mm.

Treatment using a mushroom pessary is indicated in cases where other types of pessaries are not effective. This pessary model is intended for short-term use (no more than 6-12 hours, insertion during the day and removal at night).

The choice of the type and size of pessary depends on the anatomical features of the patient, the severity of the prolapse and the presence or absence of concomitant urinary disorders (Fig. 8).

The size of the pessary is determined based on the results of an objective examination and assessment of vaginal capacity using fitting rings (Fig. 9). For treatment, a pessary with the smallest diameter should be used, which eliminates/reduces the manifestations of prolapse. If the pessary size is correctly selected, there should be a small gap between the product and the vaginal wall (10-15 mm, the width of the phalanx of the finger). Correct placement should be assessed during abdominal muscle tension (eg, coughing, straining) and movement. The pessary should not fall out when straining, cause difficulty urinating or cause pain in the vagina.

Rice. 9. Choosing a pessary size * the most commonly used pessary sizes.

The practice of simultaneous use of two pessaries is described. When using two pessaries (two thick rings of different diameters, urethral + thick ring or other combinations), a combination of supporting and filling effects is achieved. These cases are rare, but this technique can help in treating complex cases.

Assessment of vaginal capacity using the Cusco speculum is presented below (Fig. 10)

Rice. 10. Assessing vaginal capacity using the Cusco speculum

Duration of continuous use of pessaries

The duration of treatment with a pessary depends on a combination of many factors (the stability of the vaginal microbiocenosis, the degree of estrogen deficiency) and, therefore, is very individual. On average, a patient can use pessaries (except cubic and mushroom-shaped) for 30 - 40 days.

After selecting and installing the pessary, a follow-up examination should be recommended after 10 to 14 days. During the follow-up examination, the effectiveness of treatment and the condition of the vaginal mucosa are assessed. The next inspection is recommended after 30 - 40 days. Cases of successful continuous use of a pessary for more than 6-8 months have been described.

It should be remembered and understood! Selecting a pessary is a rather labor-intensive process. Sometimes, even if the doctor takes into account all the anatomical features of a particular patient, there is a need to purchase another pessary of a different shape or size. If you do not accept this option, do not seek this kind of help.

All pregnant women want the pregnancy to go well, and then they give birth to a healthy, strong baby. However, not all expectant mothers succeed in this. Some people are prescribed a pessary during pregnancy, and women are scared, not knowing what it is. An obstetric pessary is a ring-shaped device with which the uterus is fixed during pregnancy. Any expectant mother who has been prescribed this device will be interested in learning about the consequences of using a pessary, side effects and contraindications for its use.

What is an obstetric pessary

Doctors call a small ring for pregnant women on the cervix a pessary. The most common device really looks like a ring, but there are a lot of variations in the shape of this instrument - there are obstetric cup-shaped, cubic, cone-shaped, mushroom-shaped devices that perform the same function - reliable fixation of the uterus so that the fetal pressure is distributed evenly over it. An alternative to installing the device is an operation to suture the cervix, which is fraught with negative consequences.

In what cases is it installed

A terrible diagnosis - “threat of premature miscarriage” - is heard today by every fifth pregnant woman during an obstetric examination. However, not everyone gets a special ring that will protect the expectant mother from spontaneous early birth and miscarriage. Installation of an obstetric pessary is prescribed for isthmic-cervical insufficiency. This pathology is characterized by the following symptoms:

too soft and weak walls of the uterus;
constant opening of the uterine pharynx due to its damage;
short cervix.

This condition occurs after suffering gynecological diseases, abortions, constant curettage, difficult previous births, may be a consequence of diseases of the internal organs, or have a congenital form. Insufficient functioning of the uterus can lead to the fact that the membranes begin to penetrate the pharynx as the fetus grows, which can lead to infection, early rupture, and miscarriage. The use of a pessary in 85% of cases of obstetric practice helps to safely carry the fetus to term.

Types of obstetric pessaries

Each woman is individual, has her own dimensions of the vagina and cervix. Depending on these indicators, the following options for obstetric pessaries are distinguished:

1 type. Used during the first pregnancy, when the diameter of the cervix is no more than 30 mm, and the length of the upper third part of the vagina is 60-65 mm.
2nd view. The use of such obstetric rings is justified during the second or third pregnancy, when the upper third part of the vagina is 65-75 mm, and the diameter of the cervix is 30 mm.
3rd view. Such rings are relevant for women who are carrying more than one child, whose upper third of the vagina is more than 76 mm, and whose cervical diameter exceeds 37 mm.

Until when should a pessary be inserted?

Diagnosis of the functioning of the uterus, its possible weakness and insufficiency of work - all this is done by obstetricians at the end of the first trimester. However, sometimes at these times it is not possible to establish the presence of pathology, and the final diagnosis confirming isthmic-cervical insufficiency is made in the second trimester. The pessary is installed between the 1st and 2nd trimester, at 13-23 weeks of gestation. The expectant mother should be prepared to wear this obstetric device for a long time, almost the entire period of bearing the baby.

How to choose

The correct selection of an obstetric pessary is very important, because this instrument helps save the life of the fetus and relieves pressure on the uterus, so you cannot try to choose the right device yourself. The need for installation should be recommended by a qualified gynecologist or obstetrician, based on ultrasound data and visual examination of the uterus, during which its diameter and vaginal dimensions are determined.

The material for the manufacture of this obstetric instrument is silicone or special soft plastic. A gynecologist helps a pregnant woman choose the required product, pointing out the specific manufacturer, type and type. It has been noted that when using imported pessaries, fewer side effects occur, and these devices are better tolerated by the body.

How to place a pessary

Before placing the ring, you have to take smears to check the vaginal microflora. In addition, the necessary indications for the installation of this obstetric device are normal uterine tone and the absence of protrusion of the membranes into the pharynx, the diameter of the cervix is at least 30 mm, and the upper third of the vagina is at least 60 mm. Obstetricians claim that the procedure for installing the ring is atraumatic and painless, however, if you have a low pain threshold, you can ask for local anesthesia. The pre-selected structure is installed as follows:

The woman lies on her back with her legs spread wide.
The gynecologist generously lubricates the obstetric pessary with a special cream or gel and begins to insert it into the vagina with a wide base.
After insertion, the ring is unfolded so that the base is deep in the vagina, and the narrow part is under the pubic bones of the pelvis. Installation takes 15-20 minutes, after which you can get up and go home.

Do's and don'ts after inserting a pessary

You should not think that all problems are over after installing the obstetric ring, and you can relax without visiting doctors. In order for the embryo to develop normally, certain medical requirements must be observed when installing a pessary:

Vaginal intercourse should be stopped.
You should avoid heavy physical activity and try not to bend over or squat.
See a gynecologist at least 2 times a month so that the doctor, during the examination, makes sure that the device is in place and has not moved anywhere.
You will have to regularly take a smear to check the health of the microflora, since wearing an obstetric ring can provoke the occurrence of vaginal infections, which are treated on an outpatient basis.
Under no circumstances should you try to remove the pessary yourself.

Possible complications while wearing

Since the device is a foreign body inserted into the body for a long period, the following complications are possible when wearing an obstetric pessary:

Constant vaginal discharge. If this is not leakage of amniotic fluid (to rule out this option, buy the appropriate test at the pharmacy), and the discharge is clear and odorless, then you can calm down - everything is going fine.
The occurrence of candidiasis and other fungal diseases.
Inflammation of the walls of the vagina and cervix, colpitis, vaginitis.

Discharge after installation of a pessary

Immediately after installing the device, you may notice brownish bloody discharge. Normally, they should be scanty and stop 3-4 days after installing the pessary. However, if the discharge becomes more and more abundant, you should consult a doctor. Greenish discharge, as well as itching and burning of the vagina, indicate the development of a fungal or bacterial infection. This situation should also be the reason for an unscheduled visit to the gynecologist.

What does it feel like if the pessary has moved?

If the device is installed correctly, the woman should not feel any discomfort. However, if when changing position, bending, changing position, she feels discomfort and inconvenience in the uterine area, then there is a possibility that the device does not occupy the desired position. This may be evidenced by simultaneous abundant discharge of a whitish hue. If such symptoms occur, you should immediately consult a doctor so that he can correct the position of the instrument and return it to its place.

When to remove the pessary

In a normal pregnancy, the obstetric device is removed around 38 weeks, before the woman is about to give birth. If swelling of the cervix is diagnosed, then extraction may be accompanied by painful sensations. Early removal of the instrument is carried out in a hospital under such circumstances.

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

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

But as the disease progresses, 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 combat prolapse - using a pessary or intrauterine ring.

The essence of pathology

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

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 prolapse of the organ occurs insignificantly, the cervical region approaches the genital slit, but does not come out;
- more significant prolapse, in which, when straining or coughing, the cervical area may extend 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 completely comes 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 associated 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 prolapse of the uterus.

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

The pessary is sold sterile, but before purchasing the product, you must check the expiration date. All edges of the ring are smooth, they fit tightly around the cervix, keeping it from prolapse and preventing its dilatation.

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.

For older women, surgical intervention is prescribed much less frequently. This is due to various contraindications and underlying diseases of patients. At the same time, prolapse is most often diagnosed precisely after menopause, which is due to involutional processes occurring in a woman’s body.

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

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

An intrauterine ring or pessary is the only way for many women to lead an active and fulfilling lifestyle. But before deciding to install it, a woman should understand that pessaries are different - some need to be taken out and washed every day, while others can be worn constantly. Indwelling pessaries are recommended for older women as they may have difficulty re-inserting them themselves. In general, this device is convenient to use, safe, and most importantly, it solves the problem of complete loss of the reproductive organ. However, the pessary is not only intended for use by elderly patients; uterine prolapse can also occur 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 the pessary are:

partial compensation of prolapse;
the ability to lead a full life without surgical intervention;
ease of use and maintenance;
safety and hypoallergenic;
If the device is selected correctly, there is absolutely no risk of soft tissue injury.

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

the volume of discharge may increase when wearing the ring;
Possible difficulties during intimate contacts;
impossibility of use in inflammatory processes of the pelvic organs. This is despite the fact that long-term wearing is indicated for elderly women whose mucous membranes naturally atrophy, 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?

Installation of a pessary is necessary in the following cases:

uterine problems that are not accompanied by other pathologies;
the patient’s inability or desire to undergo surgery;
it is possible to cure existing gynecological defects without surgical intervention;
it is necessary to evaluate the effect of the operation;
when diagnosing urinary incontinence.

NOTE!

Before installation, you must take a vaginal smear to check for infections.

What types are there?

The main types of pessary are as follows:

supportive – supports the vagina, preventing it from descending;
thin - placed on the cervix;
thick;
cup-shaped - for removing the secretions of the gonads;
cubic;
filling – prevents uterine prolapse;
mushroom.

The doctor decides which type is best to use individually in each specific case.

The photo below shows different types of these devices.

How does the installation work?

The initial 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 inserting 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 cervix.

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

After installing a pessary, a woman should visit a gynecologist every two weeks for two months so that he can monitor the process and make sure that the device does not lead to complications.

Usually the ring is placed for six months, but for older patients it is prescribed for life.

Contraindications

Not all cases allow the uterine ring to be inserted 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, installation of a uterine ring is not advisable for women who, for some reason, cannot come to see a gynecologist at least once every six months.

Women who are sexually active are allowed to use a uterine ring only if they know how to insert it correctly themselves.

Reviews from women

Below are reviews from women about using the uterine ring:

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

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