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Pessaries, Pomegranates and Stress Incontinence
Today’s First Option for Treating Stress Incontinence & Pelvic Organ Prolapse Has a Long History Medically reviewed by Dr. Gary Emerson, McLeod OB/GYN Associates
In the 5th Century BC, physicians in the age of Hippocrates were treating urinary incontinence by inserting pomegranate fruits in the vaginas of female patients. Today’s pessary – a silicone or plastic support – is one of the most widely used options for women suffering from Stress Incontinence or Pelvic Organ Prolapse. In much the same way that an underwire bra can help support breasts, the pessary supports the bladder when inserted in the vagina, helping stop urine leakage.
“Despite advances in surgery to repair incontinence or prolapse, a pessary is often the first treatment a gynecologist may suggest,” says McLeod Gynecologist Dr. Gary Emerson. “About 2/3 of the women who choose a pessary for incontinence go on to use them over the long-term. If the pessary doesn’t solve the issue, surgery can follow.”
Occasionally, a pessary will be recommended for a short time after a mesh-based surgical repair.
There are some women for whom the pessary is the preferred solution, including those who:
- May still want to get pregnant.
- Are too frail for surgery or have other health issues.
- Have only early-stage prolapse.
- Simply desire a non-surgical solution.
- Want to delay surgery.
Some women are not suited for pessary use. They include patients who:
- Have an existing pelvic infection.
- Have an allergy to silicone or latex.
- Are “non-compliant,” the medical term for people who don’t follow their doctor’s directions.
Pessary shapes and sizes abound. So, there is likely one of the devices to fit most women. However, it may take 2 or 3 visits to your gynecologist to make sure the fit is right.
A successful fitted pessary should achieve 2 goals: 1) You don’t feel it and 2) bladder leakage stops. In one study, more than half the women with a successfully fitting pessary continued using it more than three years.
Sex with a Pessary?
Although some women choose to remove the pessary for sexual intercourse, many patients do not. Wearers should be aware that re-insertion can be tricky. Anyone planning on removing the pessary device should ask their physician for some training.
Over the Long-Term
Serious complications are rarely reported. However, ongoing care is a must for women with pessaries.
Plan on visits with your gynecologist every 2-3 months. During the exam, the physician removes and cleans the pessary, examines the vagina for infections or injury, then re-inserts the pessary.
Sources include: McLeod Health, American Urogynecologic Society, National Institutes on Health, Journal of Society of Obstetrics & Gynecology (Canada), The Canadian Continence Foundation, American Association of Family Physicians