Reader's Question: A friend had a ring inserted for her incontinence and is very pleased. I am interested in having that done. Can you tell me more about it?
Dr. Sobol's Answer: I believe what you are talking about is called a pessary. In simple terms, a pessary is a device that is inserted into the vagina, like a tampon or diaphragm and helps to support any prolapse and therefore help restore continence.
Pessaries originally were the only option women had for incontinence. As the surgical and medical field has expanded, pessaries have fallen out of favor, yet remain a very important and effective way to improve continence. They only help if you have been found to have stress incontinence, not overactive bladder or urge incontinence. That being said, some women have what I call stress-induced urge incontinence, where the leaking urine causes overactive bladder. In that instance, a pessary may help.
Pessaries are best suited for women who cannot have surgery, or choose not to have surgery to restore continence. Pessaries come in many shapes and sizes. Some of them are disk-like, and some are in the shape of a cube. Some of them have a knob that extends over the urethra and it is theoretically supposed to help support the urethra better as well. A nurse or doctor, or someone who has expertise in the field should exam you and fit you with a pessary. The pessary is inserted into your vagina, and stays there.
Once you have a pessary in place, you will need to be re-examined within a few days to one week to make sure it is the correct size, and is not causing problems. It only needed to be removed in order to clean and wash it. In general, once a week is adequate, but some people remove it daily and reinsert it themselves, and some people leave it in for several weeks and have it removed by their nurse practitioner or doctor.
Since it is not a permanent device, it is completely reasonable and appropriate to have this placed before deciding on surgery. One interesting point that needs to be made is that some women find their incontinence gets worse after having a pessary put in because it replaces a prolapsed bladder, and sometimes the urethra has been kinked by the dropped bladder therefore making her drier than she should be. Once the pessary is in place, and the kink is removed, more urine may leak out. Again, since the pessary is not permanent, there is no harm in giving it a try.
Hope this information helps.