A pessary is a soft, removable medical device inserted into the vagina, primarily used to provide support to pelvic organs that have shifted due to weakened pelvic floor muscles (pelvic organ prolapse, or POP). These devices can also manage stress urinary incontinence, which involves involuntary urine leakage during physical activities. The duration a pessary can remain inserted is highly individualized, depending on the specific device type and the patient’s care plan. Adhering to the prescribed schedule for removal and cleaning prevents complications and ensures the device remains effective.
Understanding Standard Wear Schedules
The longevity of a pessary’s wear time is determined by whether the device is managed by the patient or by a clinician. Care schedules are largely dictated by the device’s design and the patient’s ability to handle it.
Devices intended for self-management are typically ring-shaped and designed for easy removal and reinsertion. These are often used for less severe prolapse or managing incontinence. Patients managing their own pessary are usually instructed to remove, clean, and reinsert the device daily or weekly. This frequent removal prevents the buildup of vaginal secretions and helps maintain tissue health, reducing the risk of odor or infection.
Other pessary types, such as the Gellhorn or cube pessaries, are space-occupying devices that are generally more difficult for a patient to remove. These devices are typically managed in a clinical setting by a healthcare provider. Clinician-managed pessaries are usually left in place for a longer duration, often between one and three months. During the scheduled office visit, the clinician removes the pessary, inspects the vaginal tissue for any irritation, cleans the device thoroughly, and then reinserts it.
When to Remove a Pessary Before Scheduled Time
Even when following a routine schedule, certain symptoms indicate that the pessary needs to be removed immediately or that a clinician should be consulted before the next scheduled appointment.
A sudden increase in vaginal discharge, particularly if it becomes foul-smelling, yellow, or green, can signal a vaginal infection that requires prompt treatment. While a slight increase in clear or whitish discharge is common with pessary use, a change in odor or color is a sign of a potential issue.
Any experience of new or increasing pain, discomfort, or bleeding should also prompt an unscheduled removal or consultation. Pain or a sensation of pressure often indicates that the pessary may not be the correct size or that it is rubbing against the vaginal wall, which can cause tissue irritation or ulceration. Bleeding or bloody discharge is a warning sign that the device is causing friction and damaging the vaginal lining.
Patients should also seek immediate help if they experience new difficulty with urination or bowel movements, or if they feel the pessary has shifted or fallen out. The device is meant to provide support without causing obstruction, so any change in these functions suggests the pessary’s position is incorrect. If the device expels itself during straining or activity, it is likely too small and requires a refitting to ensure proper support.
Health Risks of Prolonged Use
Ignoring the prescribed removal schedule or failing to address warning signs can lead to serious health complications. One of the most common issues is vaginal erosion, where constant pressure from the device causes the vaginal wall tissue to break down. If left unaddressed, these erosions can develop into deeper ulcers, which are painful and increase the risk of infection.
Prolonged retention significantly raises the risk of severe infections, including bacterial vaginosis, due to the alteration of the natural vaginal flora. The pessary acts as a foreign object that can trap moisture and secretions, creating an environment where harmful bacteria or yeast can overgrow. In extremely rare and neglected cases, a pessary can become impacted or embedded in the vaginal wall tissue, necessitating surgical removal.
The most serious complication is the formation of a fistula, which is an abnormal connection between the vagina and a neighboring organ like the bladder or rectum. This occurs when the device wears through the tissue over a long period. These severe complications are almost entirely preventable by adhering to the recommended cleaning intervals and attending regular follow-up appointments with a healthcare provider.