Different types of pessaries - This page is currently being updated
3 Types of pessaries
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It can be confusing for patients and medical staff as to what to offer as a pessary as there is never an easy way to determine which is the best one. Its a matter of trial and error.
Here is a diagram of which pessaries are suited to which prolapse, as you can see some who have multiple prolapses will find certain pessaries cross over. Pessaries provide mechanical support to the prolapsed organs, thus relieving symptoms and improving overall body image for the patient. Pessary use and impact on quality of life and body image. Patel M.S, Mellen C, O’Sullivan D. M, Lasala C.A. Female Pelvic Medical Reconstructive Surgery (2011) Nov;17 (6): 298-301 |
support pessaries
In general support pessaries are easy to insert and coitus is possible. They tend to be less problematic with discharge as with space-occupying pessaries.
The ring pessary is usually the first choice of pessary a doctor will advise on as this is the easiest to manage, however, it is worth noting that ring pessaries are not always suitable for rectoceles.
Support pessaries are typically used for first and second degree prolapses
A support pessary is useful in the presence of incontinence where the support is on the anterior wall
Click on the pessary to take you to the full description and function of the pessary. ( please note this page is currently being updated and not all links are active at this time)
Ring - with or without support membrane
Urethra with knob
Cramer
Shaatz
Gehrung
Dish
Regula
Oval
Cup
Cerclage (used in pregnancy)
space occupying pessaries
Space occupying pessaries are useful when treating a third degree prolapse. However some space occupying pessaries are handy for those who want to practise physical activities such as sport.
The space occupying pessaries are made from silicone with the exception of the shelf pessary which is made from PVC. There are 2 types of inflatable pessaries, one is made from silicone and the other made from latex.
IncoStress
IncoLite - coming soon
T pessary
Gellhorn
Cube
Tandem - coming soon
Inflatable - coming soon
Club
The space occupying pessaries are made from silicone with the exception of the shelf pessary which is made from PVC. There are 2 types of inflatable pessaries, one is made from silicone and the other made from latex.
IncoStress
IncoLite - coming soon
T pessary
Gellhorn
Cube
Tandem - coming soon
Inflatable - coming soon
Club
Lever pessaries
The variations of the Lever pessaries are based on the design of the Hodge Pessary. Lever pessaries are used for women with multiple gestation, preterm labour and/or retroverted uterus or tilted uterus.
The levers are:
Hodge For patients with a narrow introitus.
Risser For patients with a very flat pubic arch.
Smith For patients with narrow pubic arch.
How do they work?
They posteriorly displace the cervix and antevert the uterus.
Although originally designed to treat uterine retroversion, these devices currently are used for the treatment of an incompetent cervix in pregnancy, for mild uterine prolapse with retro-version, and as a diagnostic manoeuvre in evaluation of patients with large cystoceles or urinary stress incontinence.
The pessary is inserted by first manually elevating a retro displaced uterus. The pessary is then folded and pushed into the vagina by the index finger, pressing on the posterior bar until it is behind the cervix, with the anterior bar behind the pubic notch.
The levers are:
Hodge For patients with a narrow introitus.
Risser For patients with a very flat pubic arch.
Smith For patients with narrow pubic arch.
How do they work?
They posteriorly displace the cervix and antevert the uterus.
Although originally designed to treat uterine retroversion, these devices currently are used for the treatment of an incompetent cervix in pregnancy, for mild uterine prolapse with retro-version, and as a diagnostic manoeuvre in evaluation of patients with large cystoceles or urinary stress incontinence.
The pessary is inserted by first manually elevating a retro displaced uterus. The pessary is then folded and pushed into the vagina by the index finger, pressing on the posterior bar until it is behind the cervix, with the anterior bar behind the pubic notch.