A rectocele, a common pelvic floor condition, can significantly impact daily life. While surgical options exist, a non-surgical approach involving a pessary is often considered. This device offers a way to manage symptoms and improve comfort for many individuals.
What is a Rectocele and Its Symptoms?
A rectocele occurs when the wall of tissue between the rectum and the vagina weakens, causing the rectum to bulge into the back wall of the vagina. This is a form of pelvic organ prolapse, where pelvic organs descend from their normal position. Symptoms include a sensation of pressure or fullness in the vagina or rectum. Difficulty with bowel movements is common, often described as feeling that the rectum has not completely emptied. Some may find it necessary to apply manual pressure on the vaginal wall to facilitate a bowel movement, a technique known as splinting.
Understanding Pessaries
A pessary is a medical device designed for insertion into the vagina to provide structural support for pelvic organs. These devices are typically made from soft, non-absorbent silicone, ensuring comfort and reducing the risk of irritation. They help reposition organs that have descended due to weakened pelvic floor muscles, alleviating associated symptoms. Pessaries work by gently pressing against the vaginal walls to hold organs like the uterus, bladder, or rectum in a more anatomical position. This support can improve comfort and function without invasive procedures.
How a Pessary Supports a Rectocele
A pessary helps a rectocele by providing mechanical support to the rectovaginal septum, the supportive wall of tissue between the rectum and vagina. By occupying space within the vaginal canal, the pessary acts as a barrier. This physical presence prevents the rectal bulge from protruding into the vagina.
The device reinforces the weakened tissue, helping to keep the rectum in its proper alignment. This support reduces the degree to which the rectum sags forward, mitigating the feeling of a bulge.
By maintaining the rectum’s position, a pessary can improve bowel emptying. It facilitates a more direct pathway for stool, often reducing the need for manual assistance during defecation. The continuous support offered by the pessary allows for improved rectal function and a reduction in associated symptoms like incomplete evacuation.
Navigating Pessary Use
Types of Pessaries
Several types of pessaries are commonly used for rectoceles, each offering different forms of support. Ring pessaries are frequently recommended as a first option due to their ease of use and general support. For more significant prolapse, space-filling pessaries like the Gellhorn, cube, or donut may be considered, as they provide more extensive support by creating suction or filling the vaginal space.
Pessary Fitting
The fitting process is conducted by a healthcare professional and involves a pelvic examination. The clinician assesses the rectocele’s severity and vaginal canal dimensions to determine the most appropriate type and size. This often involves a trial-and-error approach until one fits comfortably and effectively provides support without discomfort or falling out.
Routine Care and Side Effects
Routine care of a pessary is important for hygiene and to prevent complications. Many pessaries can be removed and cleaned by the individual, typically with mild soap and warm water, either daily or weekly. Regular follow-up appointments with a healthcare provider are necessary for assessment, cleaning, and replacement, especially for types that cannot be self-managed.
While generally well-tolerated, pessary use can lead to some side effects. Increased vaginal discharge is common, and sometimes irritation, odor, or discomfort may occur. If a pessary causes pain, unusual discharge (such as yellow or green), bleeding, or a foul odor, contact a healthcare provider promptly. These symptoms might suggest an improper fit, irritation, or an infection.