SAY YES TO THE PESS!
When things started sagging for me—literally—why didn’t I say yes to the pess? A pessary, that is. Maybe because I had never heard the word pessary before. I had no idea what it did or why I would need one. Did I ask enough questions? No, I did not.
The next step on my journey with pelvic organ prolapse was seeing a gynecological surgeon. My first referral came from a close friend, a retired high-risk obstetrician, who recommended a former partner of his. This being the spring of 2021, when COVID vaccines were just starting to roll out, it took six weeks until that appointment happened. Those six long weeks were emotionally and physically draining for me because I knew something was wrong and I needed something to happen—and I wanted it NOW. But, of course, I grudgingly waited, grateful to obtain an appointment at all and giving myself pep talks on patience.
Dr. Mukul at Women’s Health Associates confirmed my gynecologist’s diagnosis: Stage II Pelvic Organ Prolapse. The pictures he drew made it clear why I was needing to pee so often and with such urgency. My uterus was sagging and pressing down on my bladder. I needed specialized surgery. Then he rattled off what would likely be involved—a complete hysterectomy (I knew about those), colpopexy (what?), and anterior post colporrhaphy with sling (seriously?). All done laparoscopically (been there, done that with my gall bladder). My brain scrambled these unfamiliar words and my eyes glazed over. He explained further what the surgery entailed, then said, “While I do hysterectomies, I do not do these highly specialized surgeries. I highly recommend you see my associate, Dr. Chidimma Abanulo, a Urogynecologist.”
“However,” he said, “it will likely take a while to get an appointment to see Dr, Abanulo, and in the meantime I think it would be great for you to do six weeks of pelvic floor physical therapy (PT) while you are waiting to be seen. And I could fit you with a pessary in the meantime.”
“What is a pessary?” I asked. Here was another completely unknown word to me. I came to understand that a pessary is a removable device that is inserted up into the vagina to provide uterine support when there is a prolapse. It is a not-very-flexible ring that kinda reminded me of a diaphragm (remember those?), except that pessaries have a flat center with a few small holes that allow any vaginal discharge to pass through. There are a couple of other types of pessaries (doughnut pessary and one called a Gellhorn pessary) but what was suggested for me was a ring pessary. These are sized to fit. Big ones, small ones, green ones, blue ones. Pessaries stay put. One can learn “self-maintenance,” taking it out every couple of weeks to clean it and then reinsert it, or, alternatively, coming back to the clinic every three weeks for a nurse practitioner to remove it, and do the cleaning and reinsertion. I could have been fitted right then and there.
In my head it seemed like this was an unnecessary step since I was clearly headed down the path of surgery anyway. I said I would do the PT and wait to see the Urogynecologist. In hindsight, I was SO WRONG. I wish I had said “yes” to the pess right then and there. I know now what relief I would have felt. My uterus would have been lifted up up up, and off my bladder, relieving the pressure, making the urgency to pee not so immediate. I now wish Dr. Mukul had made a more forceful case, urging me to give it a go. But many doctors these days seem to err on the side of putting such decisions in the patient’s hands, and I am someone who can sound confident and determined even when I’m not.
I liken this to not asking for driving directions. This is something men always get accused of, but the truth is many women fall into this “false confidence camp” as well. Quite reluctantly, I admit that it is true for me. I say to myself, “I’ve got this! I know exactly what you are talking about! Oh, yes, a right, then another right, and there will be the sign for the freeway—no problem!” (I still have nightmares about a time before Google Maps when I was driving from a brunch in LA out to Westlake Village to teach an evening cooking class. I departed after receiving instructions in the manner just described and promptly got on the wrong freeway. I had no friggin’ idea where I was and called my friends in tears asking for help. Thank goodness we at least had cellphones back then!) I digress but that illustrates the point about me.
At any rate, PT sounded like a great idea, as my previous experiences had been positive and helpful. And, indeed, I learned it would be another frustrating six weeks before I could see the Urogynecologist, Dr. Abanulo. So, two weeks later I began seeing a very skilled and resourceful pelvic floor PT specialist. The process was useful, though the relief of my symptoms was … negligible. That said, I did learn a new pelvic floor muscle group beyond the kegel that helped me hold my pee a minute longer! Small victories.
If you know someone dealing with Pelvic Oregon Prolapse (POP) then please pass along a link to my Substack. Let’s open up this conversation!
Hi Diane! I lead a startup developing an over-the-counter pessary for stress urinary incontinence. And it still took me 3 years to convince my own mother to try a pessary for her prolapse. Now she’s a total pessary evangelist! There’s just something about the lack of familiarity and, as you say, physician “neutrality.” Great that you shared your story and are on here getting us all talking. Melody
There is another option called Estring which emits a VERY low dose of estrogen from the pessary ring. It stays in for three months at a time. This gives support and keeps the blood flow and lubrication flowing. I have never had a pregnancy in my uterus so that may have some bearing on the fact that I don’t have particularly leaking issues. I have been using this for almost 10 years.