Pessaries in

Clinical Practice

Pessaries in
Clinical Practice

Scott A. Farrell (Ed.)

Scott A. Farrell, BA, BEd, MD, FRCSC

Professor
Department of Obstetrics and Gynaecology
Dalhousie University
Halifax, Nova Scotia
Canada

Cover illustration: Extract from Pessaries Through the Ages, by Renee Forrestall.
British Library Cataloguing in Publication Data
Pessaries in clinical practice
1. Pessaries
I. Farrell, Scott A.
618.144062
ISBN-13: 9781846281631
ISBN-10: 1846281636
Library of Congress Control Number: 2005937769
ISBN-10: 1-84628-163-6
ISBN-13: 978-1-84628-163-1

e-ISBN-10: 1-84628-315-9
e-ISBN-13: 978-1-84628-315-4

Printed on acid-free paper

Dr. Scott A. Farrell is the inventor of the Uresta pessary and principal shareholder
in EastMed Inc., manufacturer of Uresta.
Springer-Verlag London Limited 2006
Apart from any fair dealing for the purposes of research or private study, or
criticism or review, as permitted under the Copyright, Designs and Patents Act 1988,
this publication may only be reproduced, stored or transmitted, in any form or by
any means, with the prior permission in writing of the publishers, or in the case of
reprographic reproduction in accordance with the terms of licences issued by the
Copyright Licensing Agency. Enquiries concerning reproduction outside those
terms should be sent to the publishers.
The use of registered names, trademarks, etc., in this publication does not imply,
even in the absence of a specic statement, that such names are exempt from the
relevant laws and regulations and therefore free for general use.
Product liability: The publisher can give no guarantee for information about
drug dosage and application thereof contained in this book. In every individual
case the respective user must check its accuracy by consulting other pharmaceutical literature.
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Springer Science+Business Media
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Preface

The pessary has been a component of the armamentarium for

the management of pelvic organ prolapse for more than a millennium.1 Prior to the modern age of surgery, a pessary represented the only viable option for women with symptomatic pelvic
organ prolapse. Modern clinicians tend to view the pessary with
a mixture of disdain and reluctance.2 Training in obstetrics and
gynecology programs, at least in North America, typically provides cursory experience with pessary selection and care, and
tends to minimize its importance. The modern gynecologic
surgeon relies primarily on surgical intervention for the management of pelvic organ prolapse and urinary incontinence,3 and
resorts to the use of pessaries only in cases where surgical intervention is contraindicated by medical problems.
To the pessary novice, pessaries come in a bewildering variety
of shapes and sizes with imprecise indications for selection.
Guidance will vary depending on the article one reads or the
expert one subscribes to. Given that there is a lack of consistent
and reliable guidelines for the use of different pessary models,
most clinicians tend to become familiar with a few pessary
models, which they utilize to the exclusion of most others.4
This book proposes a new rationale for the selection of pessaries, both for prolapse and urinary incontinence. The selection,
tting, insertion, and removal of the most commonly used pessaries are described and illustrated in detail. It is the contention
of this book that the modern pessary should take a central place
in the management of both pelvic organ prolapse and urinary
incontinence. Pessaries are in fact much more welcome to
women than many healthcare providers believe. The establishment of a healthcare team familiar with pessary care and the
implementation of a simplied pessary care protocol makes the
work of the healthcare provider easier. Pessaries are effective for
the management not only of pelvic organ prolapse but also of
urinary incontinence.5,6 Newer models of incontinence pessaries
are highly effective and user-friendly. By providing detailed
instructions on the tting and care of popular pessary models,
this book endeavors to convert skeptics to believers in using pessaries as a part of their clinical practice, and to conrm the practice of those who already employ pessaries on a regular basis.

vi

PREFACE

I hope this book facilitates the acquisition of condence for

pessary care novices and provides an aid to rening the practice
of those who are already expert in pessary care.
ACKNOWLEDGMENTS

I would like to acknowledge with gratitude my collaborators

who have provided invaluable contributions to researching and
writing this book. Renee Forrestalls painstaking and creative
efforts resulted in the excellent illustrations and the cover design.
References
1. Miller DS. Contemporary use of the pessary. In: Drogemueller W,
Sciarra JJ, eds. Gynecology and Obstetrics. Philadelphia: JB Lippincott, 1992:112.
2. Novak E. The vaginal pessary: its indications and limitations. JAMA
1923;80:12941298.
3. Cundiff GW, Weidner AC, Visco AG, Bump R, Addison WA. A survey
of pessary use by members of the American Urogynecologic Society.
Obstet Gynecol 2000;95:931935.
4. Wu V, Farrell SA, Baskett TF, Flowerdew G. A simplied protocol for
pessary management. Obstet Gynecol 1997;90:990994.
5. Farrell SA, Singh B, Aldakhil L. Continence pessaries in the management of urinary incontinence in women. J Obstet Gynaecol Can
2004;26:113117.
6. Donnelly MJ, Powell-Morgan S, Olsen AL, Nygaard I. Vaginal pessaries for the management of stress and mixed urinary incontinence.
Int Urogynecol J 2004;15:302307.

Scott A. Farrell
Halifax, Nova Scotia, Canada

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ix

The History of Pessaries for

Uterovaginal Prolapse . . . . . . . . . . . . . . . . . . . . . .
Thomas F. Baskett

Pessaries for Pelvic Organ Prolapse:

The Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sandra A. Baydock

10

Pessaries for the Management of

Urinary Incontinence: The Evidence . . . . . . . . . . .
Baharak Amir-Khalkhali

17

Selection of a Patient for Pessary Care . . . . . . . .

Scott A. Farrell

Selection of Pessaries for Pelvic Organ

Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sandra A. Baydock and Scott A. Farrell

32

Selection of Pessaries for

Urinary Incontinence . . . . . . . . . . . . . . . . . . . . . . .
Baharak Amir-Khalkhali and Scott A. Farrell

46

Fitting and Care of Pessaries for

Pelvic Organ Prolapse . . . . . . . . . . . . . . . . . . . . . .
Sandra A. Baydock and Scott A. Farrell

54

25

Fitting and Care of Continence Pessaries . . . . . . . .

Baharak Amir-Khalkhali and Scott A. Farrell

70

Patient Education Regarding Pessary Care . . . . . . .

Karen D. Farrell, Linda E. Irving, Jane E. Twohig,
and Joan M. Foren

81

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

91

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

95

Contributors

Baharak Amir-Khalkhali, BSc, MD, Department of Obstetrics and

Gynaecology, IWK Health Centre, Dalhousie University, Halifax,
Nova Scotia, Canada
Thomas F. Baskett, MB, FRCS, FRCOG, Department of Obstetrics
and Gynaecology, Dalhousie University, Halifax, Nova Scotia,
Canada
Sandra A. Baydock, BSc, MD, FRCSC, Department of Obstetrics
and Gynaecology, University of Alberta, Edmonton, Alberta,
Canada
Karen D. Farrell, BA, BSc, MA, School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
Scott A. Farrell, BA, BEd, MD, FRCSC, Department of Obstetrics
and Gynaecology, Dalhousie University, Halifax, Nova Scotia,
Canada
Joan M. Foren, RN, Urogynaecology Clinic, IWK Health Centre,
Halifax, Nova Scotia, Canada
Linda E. Irving, RN, Urogynaecology Clinic, IWK Health Centre,
Halifax, Nova Scotia, Canada
Jane E. Twohig, RN, Urogynaecology Clinic, IWK Health Centre,
Halifax, Nova Scotia, Canada