pessary study

Thanks for the interesting article, Christine. I was pleased to see it makes the possible "side" effects of surgery sound much worse than those of pessary use. As a person currently happy with my pessary, I was a bit depressed by the idea that most women have to give up wearing pessaries in the long term. On the other hand, at least the untoward symptoms listed would all be obvious to the woman concerned, she wouldn't be left in a fool's paradise while bad things happened unseen. I am intrigued that 27% of women were cited as having abandoned their pessaries for "physical exercise". I wonder what this means, it sounds promising but I fear just means kegels. Or are the women all following your advice? What do you think?

When I first discovered my bulges, it was I, not my GP who suggested a pessary (I having spent half the night searching the net for info). In the large group practice there was only one doctor who knew how to fit a pessary, and she was one week away from retirement! She said she thought women nowadays couldn't be bothered "messing about" with anything like that, they just wanted the problem fixed. Neither she nor anyone else in the practice I've spoken to had any idea what a huge percentage of the women who have surgery are NOT fixed, but on the contrary committed to an endless series of major operations whose outcome is more and more hopeless. This is not paraphrasing your writing but quoting from some surgeons' own websites, where the dismal prospects are clearly spelt out.

I am concerned that if pessaries are discredited, newly diagnosed women in the painful state of panic familiar to all of us will be offered NO alternative to surgery.

Your comment is excellent. There are a lot of problems with that study, not the least of which it is impossible to do it double-blind, placebo controlled. That is the gold standard of research; any study short of that must be approached with a grain of salt. Also it was a retrospective study, another minus. As you point out, using the gynecology paradigm of doctor-controlled (maybe improperly fitted) pessaries, being worn at all times, is not going to tell you much about the experience of woman-managed, part time pessary use. I found the study:

http://www.bjog.org/details/journalArticle/450181/Longterm_vaginal_ring_...

You can't read the whole thing without buying it and I can't tell from the summary to what degree these women managed their own pessary use. I suspect women who did not keep the thing in most of the time were thrown from the study. Those who quit after a few months may well have been badly fitted. Those who quit after several years may well have had hormone changes, onset of vaginal dryness, or other changes unrelated to length of time of pessary use. There is no good reason that this study group, which averaged 2 to 5 years before giving up to do something else (any pressure to have surgery there?), should be used to tell patients prospectively that they shouldn't use a pessary more than 2-5 years! There is NO scientific evidence here that more than x number of years of pessary use is harmful. I love this part: "Twelve women died during the time frame." Ooooo, better go have my panhysterctomy/A&P/VVS!

I do understand this study did not attempt to compare the long term effectiveness and complication rates of pessary use compared to surgery. But just the fact that such studies are published affect the public's thinking to a huge degree. Even if it is true that 56% of pessary users have side effects, a 1 out of 2 shot at mild, reversible side effects is not comparable to the profound, permanent complications of surgery, such as lifetime catheterization. Reports of this study are going to discourage women to forgo even trying a pessary, and opt straight for surgery.

Not this one though... she got her surgery, but first... one won't work? Try three!

http://www.pelviperineology.org/practical/triple_vaginal_ring_pessaries_...

Alix, I thought the exact same thing when I read "exercise" I thought, I hope that means they all went to WW!

What you say about the docs in your practice is frightening.

Christine, I too was taken aback about her comment about very elderly women. She is saying pessary use has long term complications, and it is true, in the very elderly, we don't worry about long term complications. They won't live long enough to have them! I thought that was a kind of a backhanded way to relate all the side effects found in her study to long term damage. But the side effects in her study do not have anything to do with long term damage. They don't show an increase in cancer rates or a rise in cholesterol or any ominous years-in-the-making problem. She is assuming things that were not demonstrated in her study.

Thanks for that article Christine, v interesting. In the the "Pessary" thread at the bottom of Christine's post there is a post from Jeannelu who mentions that her 90 year old mother has been using a pessary for over 30 years, so that should be encouraging to pessary users. Maybe it's a question of finding the right pessary and the right doctor for you, one who is skilled at fitting them and has the patience to keep trying different types.

As an occasional sea-sponge user I wonder whether the sponge could be encased in something that would be hygienic and would eliminate the scratchy/irritation drawback for those who've experienced it. I think that it's cheapness, squishiness and ease of use (no need to be fitted, can pop it in and out as required etc) would make it a good alternative to commercial pessaries if only it's drawbacks could be eliminated.

And on the subject of "props", are there any long-term users of the V brace/V2 brace out there?

These "props" can be a wonderful security blanket whilst waiting for the posture/exercises/diet to take effect and just on bad days generally, or days when you can't avoid overdoing things a bit.

Maybe one of the problems with some women's long-term use of pessaries is partly to do with the long-term effects of continued inappropriate posture and diet in conjunction with having a foreign body pushing out the walls of the vagina,who knows? One of the possible drawbacks of using props is that they allow you to carry on as usual instead of addressing the root cause of the problem.

It's obvious that most health professionals are either too unaware or otherwise motivated (ie to make money out of surgery) to even research alternatives, so it would be great to hear stories of women who have been managing even severe prolapse with alternative methods in addition to WW. Judith

Thank you Christine, good article, great response!

Oceanblue

Interesting idea. I suppose the thing is to have something that's soft and comfortable, easily sterilised, cheap, easy to insert and remove, not requiring a doctor, that doesn't entail holding the vagina open so that more prolapse can occur. And that works of course.

With the two corners, what about the retroverted uterus where the cervix seems to be pinned to the back to one side?

It will be interesting to get feedback about moulded beeswax. Judith

Have been dealing with POP for almost 16 years. Has unfortunately gradually progressed to Gr 3 UP with Cystocele. Had thought about a pessary for some time, but avoided it because in the past had used a diaphram and hated it. What I've been doing for the past few years is inserting an Ultra tampon on the side of vagina between the prolapse and vaginal wall, which does help push things up. This is kind of what Christine recommends regarding pessary design. Now need to use a tampon on either side due to worsening symptoms. Did go in for pessary fitting, but unable to get good fit. Tried Ring, Donut and cube. Almost tried the cube, but just found it too uncomfortable. So I got the surgery lecture again. So now I'm going to be more diligent about posture and loose some weight. See what happens. I can always have surgery, but really trying to avoid this. What I'm annoyed with is that my clitoris and area just below it are now feeling irritated. These symptoms at times make me feel like I actually have a UTI, because I have urinary urgency at times. UA and cultures have been negative. Have been applying KY to keep things moist and that does seem to help. Anyone out there relate to this and have any tips for treatment.

I just use Vagisil for that type of irritation. Literally numbs it. But I don't like to use it a whole lot, just once in a while when I have that "UTI" burning feeling, even though I know I don't have a UTI either.

Dear AnneH,

Just a few concerns with the use of Vagisil.

Have you checked the ingredients? Parabens ... glycerins...

Hugs,

Oceanblue

Hi Chirisitne,

What is LS?? I have no idea?? My other question....i viewd a video on nauli and almost died!! How in the heck can I do that!! I contacted a yoga instructor on my area and when we finally connect I am going to learn. I am also going to find out from her if yoga can help with my condition. BUT, I am retroflexed, and feel that it is impossible for me to get the efffects that the NORMAL women are getting. Nowhere, anywhere is there a diagram of a retroflexed uterus on line. How can I manipulate a uterus that is really standing above the vagina NOT at a 90* either forward or posteriorly?? I am doing the exercises, but i picture my uterus if anything, when I do the rocking, maybe experiencing some slightly forward movement so that it is even more compromised being right over the vagina upright. My gyn told me that my uterus is large, and very immobile. That must not be very hopeful for repostioning. As I have told you I am an xray tech; my friend was an ultrasound tech...I had her scan me a few years back.....I had fibroids. I told all of my docs and no one said anything. I saw the urogyn and mentioned it to him...nothing. Just for kicks had an off record u/s; they had all doubled in size totaling 12.5 cms of fibroids. I am finally getting a u/s jan 4th. I was annoyed that no one was interested in finding out if they really are fibriods (as a radiologist had never read my films) and my lining was very thick too!!! I said to my urogyn....I want to keep my uterus and I may be going through all this and have a diseased organ!! Could we maybe take a LOOK!!!! FINALLY I am having my FIRST pelvic u/s at 48!!!!!! on the records!!!! Unreal. My thoughts were that with those size supposed fibroids that they have GOT to have weight to them!! any thoughts on any of this my prolapse mentor!!! Hugs.....sadie

peace....sadie

early on in my wholewoman days I read about how women when they are about 20 weeks pregnant see reversal of uterine prolapse symptoms- and I wondered if there was something you could fill the uterus with to mimic the 20 week fetus- I talked with a researcher at the university here and he told me that they tried sterile water and saline solution to do this- but the uterus cramped so terribly it wouldn't work.
I wonder if fibroids are what are preventing your uterus from slipping further- and if you are able to reposition your uterus- I wonder if the additional weight would keep it there...

Now that certainly is a different way of looking at it!! Good point!

peace....sadie

Wondering if olive oil applied to vulva would be as beneficial as organic butter. Also heard about the benefits of EPA/DHA supplements. Anyone know the dose.
Thanks,
PatM

Christine you said, "I can't say enough about the amazing effectiveness of pushing up the cervix while creating a stomach vacuum." I have instinctively been doing that for a long time. And I use it to position my pessary, also, leaning forward. The pessary is positioned best when I draw the uterus up and forward in this way. In fact, I was going to make a post about this in the other thread, because I inserted it wrong today and it hurt, so I'll say more about that in the other thread.

Oceanblue, I'm not too worried about those ingredients in Vagisil, but that is why I don't use it very often.

Wait, Butter?? Seriously???? This would be good. You're not joking, right? Butter is soooo slippery. And natural. And always have it. lol Tell me it's true and I'll try it. For the pessary, right?

Beginning to sound like I'm discussing packing a lunch, with all the items I've come up with. How great would it be that it's just butter. ha.

Any thoughts on undoing the Trimo-San that I put up there? Ug. Eat a lot of carrots? lol Do a replens? But I see it as parabens. Not that I know of any reaction in me to them but geewillakers it feels like almost everything under the sun is bad for you.

O I saw an interesting Chinese video about uterine prolapse on You Tube. It was showing herbs. I wish I could understand what they were saying! lol Anyone speak Chinese? Looked like Hind ito me, actually, in writing, but sounded like Chinese.

Wait, Butter?? Outside, only I guess, egh? Not inside, right, since butter goes bad? I'm thinking of the pessary I was going to experiment with today. But trying to be certain of what I decide to use as lubricant with it.

I saw an interesting Chinese video about uterine prolapse on You Tube. Interesting because it showed fresh herbs to use. But I don't recognize the herbs and don't even know for sure if it was Chinese. : ) I'd be interested in knowing what they use.

My understanding is the butter's use if for the vulva- not as a pessary aid.

yes. sigh. for a sec i thought, o how easy! : ) i guess that's like yes we have no bananas. "yes, no butter." : )

butter is a great lube :)
and I've never had a problem with it...

Before I found you wonderful folks, I had discovered that this was the most soothing external application for me. It absorbs into the tissues more quickly than butter, which may or may not be desirable. But it cannot go bad. It also has monolaurin to support the immune system, and feels similar to butter in the application.

I only needed to use it a couple of days in a row and then I wouldn't notice a need for it.

I've used this for all kinds of skin things- it really helps with rashes etc in children- but I use the raw, I think I read somewhere that raw is better (has more of the antibacterial stuff).

I agree about the biscuits and coconut oil comment!

Just a thought; I found that a extra large tampon plus KY jelly was very comfortable and gave perfect relief from the bulge on a day out as a temporary aid.
Most of the time me and Pop rub along now.
There seems to be a market for disposable well designed "help of this nature";
the cranial osteopath I see (who put my shoulder girdle right in the past and is now helping pelvic girdle) was interesting in the way he explained things "stay up" in the natural world. Apparently structures housed in the pelvis don't stack on top of each other like a pile of bricks but are kept up in a way more akin to the Eden Project domes.
So the way Christine explains the stomach as a dome for all these organs to home in to fits beautifully.
He said Buckmister-Fuller was an expert on domes like this. Not sure if I spell his name right but he seems to be before his time...Like you Christine.
Thank you for your work. You are a life-saver!
The DVD works well in the UK.
Amel

That is such a good description. Like when you carry a stack of things but only need to actually hold on to the right and left of them. The middle ones are kind of there because of the outter ones. Hmmm.

Could we please get Buckmister-Fuller designing pessaries immediately please? lol. And give him an assignment in half architecture/half WW terms he can understand - hypothetically speaking, if the uterus dome went up would the bladder and rectal domes fall if they were sprinkled with tumeric inside? I HOPE u know I am kidding. I am slap happy from having made it home from the night shift. : )

I won't even update u on my personal dome positions. I am beginning to think "whatever." I may as well start going with a new template update of "Nicki's somewhere, so are her neighbors - Whatevah, dahlingk."

I'm glad to be surviving and in the back of my head there is hope for all righting itself. Two more pounds, btw. Holding at 22 pounds less. : ) Every pound off feels like phew, a pound Nicki and her friends don't have to have bearing down on her/them.

Aha! Buckminster Fuller has come up again. It is no coincidence that your chiropractor mentions him, and that the chiro is espousing this model of pelvic architecture. We have discussed this before, and it is the main model that affirms my belief in the Wholewoman model. I studied this at Uni in the early 1970's, as a part of structure engineering, and Bucky re-entered my life thirty years later, but now wearing a frock and a low slung hip belt, instead of safety vest and hard hat.

Check out this site. http://www.intensiondesigns.com , and click on Geometry of anatomy. If you want to google further try "tetrahedron nature" (The tetrahedron, with its twenty faces is the geometric basis of the geodesic dome structure that is the engineering basis of the skin of that EcoDome thingy) "icosahedron nature" and "tensegrity". That should keep you going for about a week of reading and will mess with your head, while knocking you out with its simple, yet insanely complex logic. It is all very real.

While this guy's models are quite hard to understand the principles are tried and true in nature.

I have made the icosohedron on Mr IntensionDesigns' homepage, out of some secondhand round electrical conduit and common garden string. You need six equal lengths. Hacksaw narrow slits at right angles to each other in the ends of each piece. Now you need to find a path for the string to pass from one member to the next, ending up with each member having all its ends crossed by two strings wedged down into each slit, ie four strings coming from each end of each member. First you do all the threading, then you start pulling the strings tighter and tighter until it rises up into a three dimensional figure. Tie the strings as tightly as you can. The ends of the two pieces of string will come together if you have wound the string in a logical fashion. The strings need to be wedged in to stop them from falling out during the construction phase, while it is lying loose on the table, but they need to be able to move in the slits as the thing takes shape, some strings getting longer while their neighbors shorten. The final structure can either kind of spherical, or almost flat on the table, and be stable in many different positions in between.

Hint 1. I think you need two strings, that eventually get tied together. Can't remember why, but I ended up with two knots.

It is like a jigsaw getting all the strings in the right order. It is probably easier to have two or three people to do it. There will be arguments. There will be tears. There will be bits of string everywhere. This is not an exercise to try while you are stoned! Do not try this exercise when there is underlying interpersonal conflict between the team! It could take a whole day to get it right, and many cups of tea, but the satisfaction, and what you learn from the process is amazing! I would call it a 'family bonding experience'. ;-)

Hint 2. Grab some toothpicks and some craft glue.
Make a triangle out of 3 toothpicks first.
Then make a tetrahedron out of 6 toothpicks. The tetrahedron is *the* most simple three dimensional figure possible. It is made from 3 triangles.
Then make an icosohedron out of 30 toothpicks. You will then be able to see that the icosohedron is made of twenty tetrahedra.

This will teach you about the triangular basis for all structures in nature. Go take a look at nature.

Have fun.

That is brilliant; am off to get a ball of string and toothpicks.
I shall need a few weeks as I only scraped a pass at GCE maths and am fairly clumsy with the old fingers....I do persevere though.
Husband has a degree in physics so I'll rope him in.
Thank you so much for your time and thorough reply.
The osteopath will be interested! You never know this could change the world of pessaries.
Much love
Amel

Dear csf
Losing a bit would be a good idea for me too.
I imagine a pessary with a mushroom shape that inserts like an umbrella and softly holds up the dome/domes and all there-in ...feather light no trouble..easy to remove and breathable and disposable..perhaps all the colours of the rainbow.
A bit different from the monstrosity they presented me with; hard as iron and vinyl plastic; no way!
It's a shame BF is no longer with us...but there must be someone out there who is to come.
Keep up the good work
Love
Amel

Yes, what surprised me most was how heavy it is.

Another topic: it seems to me that on that dramatic day when my POP was suddenly "right there' and i went into the shock and confusion and discomfort and pain, i later realized that at that very same time the awful draggy, heavy turniquet on the leg feeling had stopped. and had not returned...so all that discomfort, but i no longer felt AS STRONGLy that awful urge to sit down immediately BECAUSE OF MY SWOLLEN ACHY THROBBING FULL LEGS HURTING ME URGENTLY. like the prolapse weirdly allowed my legs to get blood circulating again.

BUT today, i had to go wait on a line at a gov office. man o man o man, now that heavy, awful, draggy turniquet feeling is back for the first time. i wish i could get rid of it. not only does it feel terrible. and prevent me from resting, it also feels to me like an alarm bell. like something else is wrong i have to fix.

i spent most of the day taking care of that stuff. i had no choice.

it was hitting me how awful it is that society has built in as if it's a good thing so many manadatory reasons to STAND ON LINES.

feet up, trying to relax, but wow, what a feeling of a stressed out body. : )

just a thought ...I acquired a shopping trolley after POP and you can get them with seat/stool incorporated. Maybe for specially hard trips to town one would help I know they are not cool but mine is quite fashionable and you could customise one ....perhaps start a fashion.... *

Sort of like a Shooting (hunting?) stick with a white rubber stopper on the end, and a shoulder strap; a kind of monopod for butts.

It would not be difficult to make, a piece of aluminium tubing, a wide bicycle seat, or even a disc with a bracket to fit the tubing, an adjustable strap attached to the seat at the top and to a bracket halfway down the tube. Crutch cap on the bottom. Voila!

Here is a link to a German company that sells a pessary very much like what you described, Christine. Today I ordered the fitting kit, which includes 4 sizes. My nurse practitioner who I'm working with to find a pessary that I can use won't work with me on it because it's not FDA approved, but they let people order them directly without a prescription. It seems to make a lot more sense than many of the other styles.

http://www.pessartherapie.de/pessary-therapy/pessary-types/t-pessary/

I have rectocele and cystocele. They're not really symptomatic, except an occasional feeling of fullness. But my concern is that I have osteoporosis and also not much muscle mass, so I really want to be able to keep exercising with weights, but am afraid that that will cause my condition to worsen. I think somebody out there needs to develop a line of "sports pessaries" so that active women with prolapse can keep being active without doing further damage. Does that make sense? Could a pessary allow me to keep lifting and running without making my condition worse?

How does one create a stomach vacuum?

Thanks.

Thanks, that's very helpful to my growing understanding of how all of this works. So am I correct in thinking, then, that with rectocele and cystocele, the problem isn't that the walls of the vagina are somehow weaker or more malleable than normal, as I was thinking, in which case I felt they needed the support of a pessary along the length of the vagina, but instead the problem is actually that due to incorrect posture, gravity has allowed the other structures to push against the vaginal walls, causing them to bulge under the pressure, in which case, what is needed is the reposturing you talk about so eloquently in the First Aid DVD? If that is true, then, I don't quite understand why some of my bulges are on the front as well as the back (which would ideally actually be the top and bottom) of the vagina, since both of those surfaces shouldn't be subject to the same force of gravity. I'm not sure if my question is clear. I'm still struggling to get my mind around this different conceptualization of the problem.

Posture before Pessary; Pessary before Surgery - I had only quoted this from you- but in a complicated world, simplifying things has more real effect than complicating things...
I think there is some Chineese proverb to the effect that the more complicated sthg gets, the more simple it gets.

Christine, would you have any thoughts/advise on whether I could successfully re-isnert the 3.5 inch donut pessay and see how I feel for a few days w/o it? I did remove it once in nurse's presence but she re-inserted it while I expressed shock in the blood on it...
I gives my great relief from the sag I have but I am starting to question whether I want the constant stretchiness I feel. Still better than sag..
I am to see gyn in Aug for removal and assessment - hope to ask him re the ring with support..

Listening to Simon & Garfunkel on a very good stereo and just looked at this website- thank you for sharing-- I am confused as to why these can be ordered but are not available for sale in Canada-- will I ever know all there is to know about rules, regulations and reality haha
I am still impressed with the doughnut pessary. I seems to lie above the public bone and really doesn't feel (by finger touch) to be as large as I first thought it to be. When I have a full bowel, I do really feel the sensation of its presence. In "polling the audience" here on web sites, it appears one has better success with a pessary if left alone for awhile.
Not that it is the same but when I was first given dentures, the one doctor put them rite in after pulling my teeth and told me to leave them in at nite. It was 5 year later that a differnt dentist strongly advised removal every nite ...
I hope to end up removing the pessary at nite but am hesitant to take it out for fear I decide to leave it out and it has been too long that the sag has controlled my behaviour.
I also find it easier to keep my lumbar curve nicely curved and not slouch with the pessary in. I find myself also more "junk food resistant" with the little reminder I have below my tummy of GOOD food versus ANY food
Not being dedicated to the labour force is also helping me focus more on the posture, clothing, diet, exercise
Some pessary sites do speak of pessaries helping to improve the POP.
My suspicion for me is that if I were to take the pessasry out- things would stay up only for a while.. I think I need to loose more weight and maybe get a smaller ring.
I have decided that the lifting is not going to take me in a positive direction and I will avoid lifting as much as possible. (It is not possible for me to not lift grandkids - It is too much a pleasure.
I notice I am loosing muscle mass- quite a surprize for a 63 yr old who still thinks she is 35 Haha
Going to change Simon and Garfunkel side B - they are inspirational -forgot how much they move me - wishing You well.