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Re: pessary,...uterine prolapse..
From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Thu, 19 Oct 2000 09:46:04 -0500 (CDT)
Cindy,
Well there are many many different types of pessaries out there and the
best way to find one suited for a particular patient's needs and anatomy
is to just try the different ones.
Whether or not you wear a pessary is primarily based upon either
symptoms (pelvic pressure, feeling of falling out, chronic
pain/discomfort or actual cervical irritation if the prolapse is
significant enough)or difficulty with urinary incontinence or voiding or
evacuating stool during a bowel movement. If you are not bothered by
these things, then there is certainly no requirement to use the pessary
or have surgery. Unfortunately, pelvic relaxation tends to be a
progressive problem over time. As we get older, the tissue that is
still holding things semi-in-place, begins to weaken. Additionally, as
one begins to go through menopause, the relaxation tends to accelerate
with loss of estrogen support to the tissue.
This whole thing of pelvic relaxation seems to be more related to the
individuals innate tissue integrity. In other words, some of us are
built with tissue that seems to withstand anything, others have tissue
that tends to loose its integrity over time. At age 34, if you have
significant prolapse, I would be concerned about your tissue integrity.
There are certainly surgical procedures that can correct the problem.
The most effective ones seem to involve removal of the uterus at the
time of the repair. This obviously necessitates loss of the ability to
have children, so if you are planning future pregnancy, it isn't a good
option. Further, if you have a repair with the idea of having a
pregnancy afterward, it doesn't make much sense because there is a
potential for the pregnancy to damage the repair. The surgical
procedures for this problem can certainly fail. I have found that the
younger the patient with the problem, the more likely the failure-again,
back to the tissue integrity issue. On the other hand, age 34 is too
young to be debilitated by pelvic prolapse. So, one had to weigh the
symptoms, quality of life to determine the right path for them.
Incidentally, I also think that age 34 is too young to be a slave to a
pessary. If you were my wife, sister, I would recommend a surgical
repair IF the symptoms are causing you problems. If the symptoms are
currently managable, I would forget the pessary and follow things over
time...
Lynn
At Wed, 18 Oct 2000, Cindy wrote:
>
>Just another question....why aren't pessaries designed for those in their
>30's, 40's etc? I am 34 and really don't want to have surgery to correct
>this. Does it hurt if I don't wear a pessary? Is it just a comfort issue?
>
>My doctors office is giving me 3 pessaries tomorrow to try. I hope one
>works but I ma not holding out hope.
>
>If I have surgery what is involved? I have a grade 2 prolapse and erctocele
>and cystocele. Can this surgery fail?
>
>--
>Cindy
>>----- Original Message -----
>From: <anonymous@obgyn.net>
>To: Multiple recipients of list WOMENS-HEALTH
><womens-health@mail.medispecialty.com>
>Sent: Wednesday, October 18, 2000 11:00 AM
>Subject: Re: pessary,...uterine prolapse..
>
>> At Tue, 17 Oct 2000, Cindy wrote:
>> >
>> > I was diagnosed 1 week ago with grade 2 prolapse. Prior to
>> >this, I had cramps and a lower backache for 1 month. I got a
>> >pessary a week ago today. When my doctor inserted it I felt
>> >fine. I walked around for 1/2 hour to see what it would feel
>> >like. I could push it down but still it wasn't uncomfortable.
>> >That evening I needed to have a BM. I found though that I
>> >couldn't. I tried to bear down ad when I did this I pushed the
>> >pessary out. Once the pessary was out I had a BM just fine. I
>> >also developed pain with it. Pain mostly while sitting. I
>> >called my doctor on Thursday and she gave me ideas to work
>> >with. She said she would see me on Tuesday (today). I tried
>> >her suggesstions but was unsuccessful. I also noticed that the
>> >cramping got worse with the pessary in place.
>> >
>> >I went to see her today (btw...she was on call and made special
>> >arrangements with me to come into the office to see her! She is
>> >such a fabulous doctor!). At first she was going to try the
>> >doughnut one but dropped it on the floor. I was glad! it
>> >looked huge to me. So, she tried a ring. I was able to take it
>> >out and put it in correctly while there and I didn't feel it.
>> >Well, as I was driving home I started having some cramping and
>> >pressure. Once I got out of the car and walked around I
>> >realized that I was feeling the pessary again. It feels like I
>> >have a tampon in and the tampon has slipped down out of place.
>> >I have this urge to try to push it back up but it is not out of
>> >place. On top of that, I have the worst backache. I had hoped
>> >that with the pessary in place the cramping and backaches would
>> >stop.
>> >
>> >Questions: Does any of this sound familiar or am I just
>> >different? What should I do? I don't want to call my doctor
>> >again. Is it possible I won't be able to wear a pessary? Will
>> >I ever get used to this thing? I just can't see how I could
>> >adjust. Please share with me if this is normal or not. I am
>> >feeling very down on myself and very much like a complainer. I
>> >ahte to be a nuisance. Is it possible that I am just too sensitive? I
>seem to feel everything in that area.
>> >
>> >Thanks
>> >
>> >--
>> >Cindy
>> >
>>
>> This is a VERY typical pattern, and is the precise reason why pessaries
>> are poorly tolerated by younger, active women. They are ackward and
>> uncomfortable for many, particularly if the patient is mobile. What is
>> great for a nursing home patient, may not be suitable for a 40 or 50
>> year old with prolapse. This is why surgery for prolapse is so common.
>> It simply does a better job for active women.
>>
>> --
>> William D. McIntosh, MD, FACOG
>> Clarksville, TN
>>
>> This is for educational purposes only, and is not intended to be
>replacement
>> or substitute for consultation and examination by an appropriate medical
>> professional. Due to time constraints, private e-mails cannot be
>answered.
>>
--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana
**Note: Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.
**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.
**Thank you for your understanding ;-)
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