Author(s): Poma PA
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Abstract Uterine procidentia is relatively common among white multiparous women. The incidence increases with age in association with other predisposing factors. Conservative management of uterine prolapse is rare today, perhaps due to definitive results with surgical therapy and the high incidence of earlier hysterectomy. Still, physicians should become familiar with pessary use and its complications. Three conservatively managed cases of pessary incarceration are reported. Applications of estrogen cream improved the condition of the vagina, permitting removal of the incarcerated pessary a few day later. Careful instruction of patients and relatives about follow-up care can prevent such complications. PIP: Uterine procidentia and pelvic-floor hernia are quite common among postmenopausal multiparous Caucasian women. Predisposing factors are age, obesity, childbirth trauma, neurologic disorders, and musculo-fascia weaknesses. Hysterectomy and pelvic floor repair constitute the definitive therapy for pelvic floor hernia and uterine prolapse, but vaginal pessaries made of rubber or plastic can also be of therapeutic value. Pessaries also facilitate preoperative healing of the vaginal or cervical ulcerations which are quite common in longstanding cases of uterine procidentia (third degree prolapse). Common complications of pessary use are vaginal irritation, allergic reactions, leukorrhea and bleeding. Hard pessaries have fewer associated complications. Proper fitting and continued post insertion care are necessary. Unless contraindicated, acid douches and or creams and estrogenic creams should be used with the pessaries. Pessaries should be removed every 6 weeks for cleansing; otherwise, ulceration, superimposed infections, and fistulas could develop. In cases of incarcerated pessaries, the use of estrogenic creams (which improve the condition of the vagina) will easily help remove the pessaries. 3 case reports are briefly discussed to illustrate the management of incarcerated pessaries in elderly women. The patients reported in these cases did not have follow-up care after insertion of the pessary, thus requiring intervention years later. Patients with bleeding problems despite normal cytologic findings should undergo fractional curettage later to rule out malignancy. Although incarcerated pessaries rarely occur, application of estrogenic creams will easily remove them.
This article was published in J Am Geriatr Soc
and referenced in Journal of Pain & Relief