Pessary Use and COVID-19
By Cara McDougall, Reg. PT
DISCLAIMER:
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. PPHC expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.
What is a pessary?
A pessary is a removable silicone device that is inserted into the vagina like a tampon.
Purpose
1. Pelvic organ prolapse: to lift/support the pelvic organs from below and decrease symptoms of heaviness, pressure or bulging.
2. Stress urinary incontinence: to decrease urinary leakage by compressing the urethra (the tube that drains the bladder).
A pessary is a conservative management option that can greatly improve quality of life for those women suffering from symptoms of pelvic organ prolapse or stress urinary incontinence. To learn more about the basics of pessaries, read our previous blog on ‘pessaries for prolapse and urinary incontinence’.
Managing pessaries during a global health pandemic?
Covid-19 has changed almost every area of life over the last few months: how we buy groceries, where we work from, and access to medical care. Virtual medical visits have become the norm as all non-essential medical appointments have been cancelled or postponed. For those who wear pessaries and rely on a nurse, doctor, or physiotherapist to remove, clean, and reinsert their pessary every couple of months, COVID-19 has interrupted this routine care, leaving many women worried about the pessary being inserted for too long, without being cleaned. This blog is meant to provide information and tips about managing a pessary independently, while awaiting an in-person medical appointment. We will cover how to remove and insert three of the most common pessaries, as well as how to sufficiently clean the pessary.
Ring Pessary with Support Insertion and Removal Instructions
Insertion
Wash your hands
Position: half squat, one foot on a stool, lying
Apply lubricant (preferably organic, paraben and glycerin-free, water-based (not silicone)) to vaginal opening and one end of the ring pessary
Fold ring pessary in half (as an “A” or a “V”)
Spread the lips of your vagina apart with one hand and insert pessary at the base of the vagina with the other hand
Gently push the pessary as far back into the vagina as it will go
Ensure proper positioning once inserted: ¼ turn so largest hole is to the side, back of the pessary slightly higher than the front, front anchored behind the pubic bone
Removal
Wash your hands. Use a glove on one hand if you find that helps to get a better grip.
Manipulate ¼ turn so largest hole is facing up to your pubic bone (12 o’clock) with your index finger
Grab the rim of the pessary with your thumb and index finger, tilt it slightly down and gently pull down and out, folding it with your other hand as you remove it. Instead of using your other hand to fold it as you remove it, you can bend it slightly by pushing your thumb down and using your ring finger to push up on the underside of the pessary as you withdraw it.
Tip: can bear down to lower the pessary or tie dental floss onto the pessary to aid in removal
Tip: try removing pessary in standing vs lying
Tip: if you cannot bend/fold it, turn pessary to a 45* vertical angle so you are not withdrawing it horizontally
Correct Fitting
No feeling of heaviness, pain, bulge, or the pessary
Pessary either should not be visible or only slightly visible when labia are separated
Better urine and stool evacuation
Better quality of life
Incorrect Fitting
Pain or difficulty urinating or defecating
Unusual secretions (odour, color, quantity)
UTI symptoms
Itching
Blood on the pessary or vaginal bleeding
Discomfort or pain at rest or with effort
Not sure if it is positioned well (just doesn’t feel right)
Gellhorn Pessary Insertion and Removal Instructions
Insertion
Wash your hands
Position: half squat, one foot on a stool, lying
Apply lubricant (preferably organic, paraben and glycerin-free, water-based (not silicone)) to one end of the disk
Fold the handle parallel to the disk
Spread the lips of your vagina apart with one hand and begin to insert the pessary
Gently push the pessary as deep as it will go, noting that the handle may be seen or felt near the vaginal opening even when correctly in place
Removal
Wash your hands. Use a glove if you feel that helps get a better grip.
Insert one finger above the lip of the disk to break the suction
Hold the handle with the other hand and slowly pull pessary out while maintaining the suction at a minimum
Tip: can bear down to lower the pessary in order to help reach above the disk. Turn the disk to a 45* vertical angle so you are not withdrawing it horizontally
Correct Fitting
No feeling of heaviness, pain, bulge, or the pessary
Better urine and stool evacuation
Better quality of life
Incorrect Fitting/Reconsider use of Pessary
Pain or difficulty urinating or defecating
Unusual secretions (odour, color, quantity)
UTI symptoms
Itching
Blood on the pessary or vaginal bleeding
Discomfort or pain at rest or with effort
Not sure if it is positioned well (just doesn’t feel right)
Cube Pessary Insertion and Removal Instructions
Insertion
Wash your hands
Position: half squat, one foot on a stool, lying
Apply lubricant (preferably organic, paraben and glycerin-free, water-based (not silicone)) to all edges of the cube
Spread the lips of your vagina apart with one hand and orient the cube so that it enters the base of the vagina by 1 of the 8 corners
Squeeze the cube as you slowly rotate it into the vagina until it is completely inside
Push the pessary deeper with 1-2 fingers of one hand while 1 finger of the other hand gently pulls the internal vaginal tissue down towards the vaginal opening
Removal
Wash your hands. Use a glove if you feel that helps maintain a better grip
Slide one finger along the vaginal wall
Break the suction on one or more sides of the cube
Slowly “unroll” the cube in the direction of the vaginal opening
Repeat breaking the suction and unrolling until the cube is low enough to grasp with your index finger and thumb and remove fully.
Note: do NOT remove the cube by pulling on the string. Doing this does not break the suction and can pull the tissues in a downward direction. Additionally, the string can break off, leaving a sharp edge. It is OK, however, to use one hand to apply a small amount of tension on the string as you use your other hand to break the suction and roll the cube out.
Correct Fitting
No feeling of heaviness, pain, bulge, or the pessary
Pessary either should not be visible or only slightly visible when labia are separated (string may be hanging outside of the vagina or tucked just inside the vaginal opening)
Better urine and stool evacuation
Better quality of life
Incorrect Fitting
Pain or difficulty urinating or defecating
Unusual secretions (odour, color, quantity)
UTI symptoms
Itching
Blood on the pessary or vaginal bleeding
Discomfort or pain at rest or with effort
Not sure if it is positioned well (just doesn’t feel right)
Cleaning Instructions (adapted from instructions provided by pessary manufacturers):
Prepare a cleaning solution by mixing a mild, unscented soap (such as Dawn® or equivalent) with warm tap water using the soap manufacturer’s recommended concentration. Do not use anything harsh on the pessary as it may damage it (no rubbing alcohol or boiling of the pessary). Prepare this solution in a container large enough to fully submerge the device.
Remove pessary as per instructions.
Run pessary under warm water and dislodge secretions by rubbing the pessary with your fingers.
Soak the device in the container of prepared soap solution for a minimum of 5 minutes.
Following the 5-minute soak period, scrub the device for a minimum of 15 seconds with a soft-bristled brush, such as a toothbrush. Scrub device below water line to prevent spraying.
Following scrub, inspect device for visible soil residue.
Remove the device from the soap solution and thoroughly rinse under flowing tap water for a minimum of 30 seconds.
Allow to air dry or dry with a clean, non-shedding towel.
Store in a dry, safe place (face cloth or pessary box).
Reinsert as needed as per instructions.
Your pessary should last 1-5 years if handled with care.
Make it a habit to inspect your pessary for any cracks before inserting it. If you spot any, replace your pessary immediately, as cracks can harbour infection causing bacteria.
Despite the changes in place to combat COVID-19, if you experience any symptoms out of the ordinary due to use of your pessary, such as pelvic pain, vaginal bleeding, or difficulty emptying your bladder or bowels, don’t hesitate to call your physician’s office to determine if an in-person appointment is necessary.
If you would like further instruction on how to remove your pessary, feel free to give our clinic a call. We’d love to hear from you and help!
Wishing you health and happiness during this unprecedented time.