Even 50-40 years ago, pregnant women could lose a healthy fetus at the end of the first trimester of pregnancy or at the beginning of the second due to premature dilatation of the cervix. The fact is that in those days the only way to combat this phenomenon was to suture the cervical canal, and since such an operation can only be performed under anesthesia, it had to be postponed until a later date. Fortunately, today such situations are extremely rare, since doctors use special devices - obstetric pessaries. They are not sold in pharmacies and it is not recommended to try to install them yourself.

Pessary: ​​what is it

To denote the problems associated with premature dilatation of the cervix, in medicine, the term "isthmic-cervical insufficiency" is used. To prevent it negative consequences such as miscarriage, doctors often recommend installing a discharge pessary. Classic version such a device, created taking into account the anatomical features of the structure of a woman's body, consists of several plastic or silicone rings connected to each other.

Views

Reviews about which are presented at the end of the article are of several types. In particular, the pharmaceutical industry produces such devices in three sizes:

• First... Such pessaries are suitable for women who have given birth less than 2 times, as well as for pregnant women with a length of the upper third of the vagina from 55 to 65 mm or with a cervical diameter from 25 to 30 mm.
• Second... Devices of this size are used for pregnant women who meet the criteria corresponding to the first paragraph, but the length of the upper third of the vagina in which is from 66 to 75 mm.
• Third size. These are the largest pessaries that obstetricians install for mothers who have given birth many times, as well as for women whose length of the upper third of the vagina exceeds 76 mm or the diameter of the cervix ranges from 30-37 mm.

Surely many people think about a pessary that it is one or more interconnected rings. However, there are many types of such a device of a completely different shape. For example, a cupped pessary is sometimes inserted into pregnant women to support the cervix, relieve the pressure of the fetal head on it, and to prevent the uterine pharynx from opening. In addition, with isthmic-cervical insufficiency, a donut-shaped device (thick ring) made of polyvinyl chloride can be installed. This material has the property of thermoplasticity and, being inside a woman's body, becomes soft, taking the shape of the organ in which it was placed. Also, for the manufacture of a pessary, silicone is often used, which does not cause allergic reactions. Such devices are pre-sterilized using gamma radiation.

In what cases is it installed

An obstetric pessary during pregnancy is installed in order to keep the uterus and adjacent internal organs in correct position... Moreover, very often it is prescribed in the case multiple pregnancy... In addition, various types of pessaries are used to address the health problems of non-pregnant women. In particular, they are effective when it is necessary to prevent hair loss. internal organs(uterus) or to alleviate the condition of the patient who is experiencing incontinence.

Contraindications and possible negative consequences

Although obstetricians usually answer all concerns of pregnant women about the pessary that it is completely safe, there are cases when it is prohibited to put it. In particular, this cannot be done if:

• there are suspicions of a frozen pregnancy;
• the lower part of the fetal bladder is already in the vagina;
• spotting and / or ichor is observed;
• revealed inflammatory processes of the genital organs.

If such a device is chosen or installed incorrectly, or for some reason has shifted, then the pregnant woman may develop inflammation (colpitis), which can be eliminated by correcting the position of the pessary and applying medication.

How to put the pessary

Before such a procedure, it is necessary to undergo an examination and, if any infections of the genitourinary organs are detected, to treat them. In addition, if a pregnant woman has an increased one, then 30-60 minutes before the installation of the ring, she is given an antispasmodic that relieves contractions, and medical glycerin is used to reduce friction. Only then can the pessary be inserted. That this is quite unpleasant, any woman will confirm. However, sometimes this procedure is the only way to maintain a pregnancy, especially on early dates when it is impossible to perform a surgical operation to suture the cervix.

When can I put

Most often, a pessary, reviews of which are mostly positive, is placed after the 20th week of pregnancy. However, as already mentioned, sometimes, due to the threat of miscarriage, you have to do this already at 12-14 weeks. In this case, regardless of how many times the pregnant woman has already given birth, the ring of the first size is always used.

Do's and don'ts after installing the pessary

After this was placed on the cervix of a pregnant woman assistive device, a woman does not need to do anything special. The only thing that doctors recommend after installing the pessary is to take a smear from time to time (once every 14-21 days) to study the bacteriological flora, and to prevent infection, treat the vagina every 2-3 weeks, and, of course, refrain from sexual activity. Moreover, the woman would have had to follow the last advice, even if she had not been given a ring. After all, when it comes about the advisability of such a procedure, then this fact itself indicates the presence of a threat of premature termination of pregnancy.

Childbirth

Usually, the device we are considering is left until the 36-38th week of pregnancy. Then the pessary is removed by the gynecologist on an outpatient basis or in a hospital. This procedure is done without anesthesia, but lasts only a few seconds, so if pain occurs, it is extremely short-lived. Sometimes it is done in a hospital, in the department of pathology, and sometimes on an outpatient basis. Removing the pessary leads to the fact that the cervix relaxes, and under the pressure of the fetus, it softens very soon, followed by shortening and opening. After that, somewhere within a week (sometimes this period may be a little longer), the woman begins labor. However, there are situations when this device has to be removed ahead of schedule. For example, this must be done if effusion is observed. amniotic fluid, the fetal bladder is infected or you have to make an emergency delivery.

Obstetric pessary: ​​reviews

Today, the installation of such devices is quite common. Therefore, many comments can be heard regarding their effectiveness and the problems associated with the use of pessaries. In particular, women complain about the discomfort they experience when they have to make long trips by car or just sit for a long time. In addition, there is also a deterioration caused by the pessary. Reviews also show that the procedures for installing and removing it can give women quite tangible pain. But the most unpleasant thing, in the opinion of pregnant women who have such a protective obstetric device, is a sharp increase in the amount of discharge 3-4 weeks after the insertion of the pessary, which is associated with the body's desire to get rid of the foreign body. Some patients even say that there can be so many of them that there are suspicions of amniotic fluid outflow and that you have to constantly wear pads.

Now you know what an obstetric pessary is, reviews of which you may have heard from friends and acquaintances. In any case, we can say with confidence that at the moment there have been no cases when the use of the mentioned medical device would cause serious health problems - neither before childbirth, nor after. However, doctors warn that even with an installed pessary, sometimes (albeit very rarely) a miscarriage can still occur. At the same time, statistics show that after such devices were installed in the early stages of isthmic-cervical insufficiency, the number of positive pregnancy outcomes increased significantly.

The uterine rings are simple, convenient and absolutely safe way treatment of uterine prolapse. Due to their versatility, pessaries allow very effectively, without the use of radical measures, to solve specific gynecological problems of a woman.

Being a strong smooth muscle organ, the uterus can sometimes change its position in the pelvic cavity and move into the vagina or external genital fissure. In this case, there is a prolapse or prolapse of the organ, which partially or completely comes out, giving the woman a lot of inconvenience. The most common complaints in such cases are pulling pains of varying intensity in the lower back, lower abdomen and sacrum, a foreign body sensation in the perineum, as well as great discomfort during normal hygiene procedures or during sexual intercourse.

There are four stages of prolapse:

• I - a slight displacement of the uterus from top to bottom;
• II - initial prolapse, when the cervix is ​​shown when straining from the genital fissure;
• III - partial prolapse - part of the body of the uterus protrudes from the vagina already at rest;
• IV - complete loss.

Treatment is selected according to the type and severity of organ prolapse. However, the best therapeutic and alternative method, known to Hippocrates, for the "reduction" of the uterus are special uterine rings.

The main types, shapes and sizes of pessaries

Pessaries or rings for the uterus are flexible silicone medical products that are designed to create additional support, fix the organ when it is displaced, and also as a barrier that prevents the prolapse of the uterus, rectum, Bladder or sagging vaginal walls. Due to its elasticity, this device, after being inserted inside, easily takes the desired position and does not at all affect the woman's freedom of movement and her usual rhythm of life.

The shape and size of the rings are different:

• thin;
• curved (Hodge pessaries);
• mushroom;
• cup regular or perforated;
• tandem;
• urethral;
• cup-urethral;
• cubic;
• adaptive.

The diameters of the pessaries are also uneven and range from a minimum of 50 mm to a maximum of 100 mm. Moreover, according to the type of appointment, they are distinguished:

1. Obstetric rings. Shown to pregnant women in order to avoid the threat of premature birth and for the prevention of ICI (isthmic-cervical insufficiency).
2. Gynecological rings. Used for prolapse / prolapse of the uterus and the organs of the female reproductive system.

Definition and selection the right kind and the size of the pessary is solely a medical prerogative.

However, it is important to distinguish between vaginal and uterine rings. The former act as a barrier method of contraception, while rings for the uterus are a therapeutic and prophylactic device. You can buy the necessary pessary in pharmacies or medical equipment stores, but only after consulting a gynecologist.

Advantages:

• Effective therapy for uterine prolapse.
• Help in preserving pregnancy and preventing the risk of premature birth.
• High performance at any stage of pregnancy and with varying degrees of prolapse of the uterus.
• Hypoallergenic.
• Safety and ease of use.
• Absolute absence of risk of injury to soft tissues.
• A good alternative to a surgical method of treatment (various types of operations are discussed here).

Disadvantages:

Pessary insertion

The primary introduction of the uterine ring is carried out exclusively by a gynecologist in an outpatient clinic. In the future, a woman, with the help of simple manipulations, can carry out this procedure on her own. Its installation is always preceded by an individual examination for infectious and bacteriological inflammations. Before direct insertion of the uterine ring, it is sterilized by boiling or rinsing in hot water. For a smooth and easier installation, the device is treated with vegetable oil or sterile petroleum jelly.

The pessary is always inserted while lying down. During this process, the ring is compressed and inserted deeply into the vagina so that, unfolding, the convex surface of the pessary is facing the cervix. During and after this procedure, subject to the correct selection of the shape and size of the ring, the woman should not experience any pain or discomfort.

In this video you can see the technique of introducing one of the types of pessary:

Further, every two weeks for 1.5 months, an examination by a gynecologist is required for the normal position of the device and the absence of the development of possible concomitant complications. The average wearing time of the ring is from 2 to 6 months, depending on the history of prolapse. If the pessary does not involve constant wearing, it must be treated with an antiseptic before each subsequent introduction.

RumisPhoto / depositphotos.com, photography33 / depositphotos.com, ruigsantos / depositphotos.com

Uterine ring No. 3 rubber (pessary) - description:

Uterine ring No. 3 rubber (pessary) is used for the polyactive treatment of uterine prolapse, prevents prolapse of the uterus, facilitates the functioning of the pelvic organs, reduces discomfort, which improves psychological well-being. The uterine rings are also used to correct uterine displacements and urinary incontinence (due to pressure on the urethra through the anterior wall of the vagina).

Uterine ring No. 3 rubber (pessary) is produced in three sizes and marked accordingly: No. 1, No. 2 and No. 3, where the larger the number, the larger the ring.
The history of the use of pessaries to treat vaginal and uterine prolapse dates back to the time of Hippocrates. Ring pessaries, or as they are also called ring pessaries, were proposed for the correction of prolapse in the 16th century by the French physician Ambroise Paré. The placement of the uterine ring was first described in detail by the Dutch surgeon Hendrik van Deventer.
In the 17th century, doctors had four types of uterine rings. They were made from cork, wood, silver and gold. They were replaced in 1783 by rubber products. Plastic rings appeared in 1950 and were used until 1990, when silicone was used for production.
The use of pessaries is part of the conservative treatment of pelvic organ prolapse, along with behavioral therapy, diet, stool and urination regulation, and pelvic floor muscle training.
Before proceeding with the treatment of prolapse, the doctor determines the degree of prolapse of the vagina and uterus and, accordingly, selects the shape of the pessary: ​​ring, cup, cubic or mushroom.
A simple uterine ring is recommended for prolapse and prolapse of the uterus of I, II degrees.
Uterine ring No. 3 rubber (pessary) is used in gynecological medical practice strictly according to the doctor's prescription.

Uterine ring No. 3 rubber (pessary) - method of application:
Before buying a pessary, you need to decide on its size - the product must be securely held in the vagina, not displaced or slip out when straining.
The initial installation of the pessary is the priority of the gynecologist, i.e. - established only by a doctor.
It is recommended to visit a doctor two weeks after installing the product. Subsequently, it is necessary to visit a gynecologist once every three months.
A woman herself should have the skills to install and remove a ring (pessary).
The maximum period for the product to remain in the vagina is 21 days, then it must be rinsed, treated with an antiseptic and reinserted into the vagina.
Older menopausal women are advised to use estriol cream to facilitate the use of the uterine ring. This female sex hormone has an anti-inflammatory and regenerating effect, prevents the development of colpitis, cervicitis, eliminates the symptoms of irritation and itching of the vulva.

Uterine ring No. 3 rubber (pessary) - indications for use: Treatment of prolapse of the pelvic organs of the I-II degree. According to statistics, 3 months after the size of the genital gap in women decreases by an average of a quarter. After a year, the degree of prolapse of the vagina and uterus is noticeably reduced, 61% of patients are satisfied with the results of use.
Multiple therapy for moderate and severe prolapse in women who categorically refuse surgery.
Pessaries are the main method of treating prolapse in elderly women with concomitant diseases that prevent surgical treatment.
As a means of preparation for surgery and a method to assess the likely effectiveness of the forthcoming surgical intervention.
For the diagnosis and treatment of urinary incontinence.
, pre-sterilization cleaning and sterilization:
Uterine ring No. 3 rubber (pessary) can be disinfected by immersion in a 3% hydrogen peroxide solution (GOST 177) at a temperature of at least 18 ° C. Exposure time 180 ± 5 minutes.

Pre-sterilization cleaning is carried out by immersing the ring in the following detergent solution (holding time 15 ± 5 minutes):
1) 17 cm? hydrogen peroxide (GOST 177)
2) 5 g detergent("Progress", "Astra", etc.)
3) 978 cm? drinking water (GOST 2874) at a temperature of 50 ± 5 ° C

Solution temperature during ring washing is not maintained. Then the ring is washed in running water and dried at room temperature.

Sterilization of the uterine ring No. 3 is carried out by immersion in 6% hydrogen peroxide (GOST 177) at a temperature of at least 18 ° C. Exposure time 360 ​​± C5 minutes. Then the product is washed with distilled water and dried at room temperature. Tool table (2 shelves, stainless steel and glass) is delivered unassembled in a compact box and is quickly assembled.

Uterine ring No. 3 rubber (pessary) - Contraindications and restrictions for use:
Acute infections and inflammatory diseases vulva, vagina, cervix, pelvic organs (endocervicitis, colpitis, cervical erosion, rubber allergy, genital anomalies).
Vaginal bleeding of unknown etiology.
Allergic reactions to the latex from which these products are made.
High sexual activity in the absence of skills in using a pessary. The ability to independently insert and remove the ring (pessary) is a prerequisite for its use. It is recommended to remove the product before intercourse to avoid injury to the genitals.
Pregnancy is strictly as directed by your doctor.

Prolapse or complete prolapse of the genitals in adulthood is a common diagnosis. This is the end result of a chronic displacement of the genitals that goes unnoticed for a long time. what to do in old age? Let's talk about this topic in more detail.

Uterine prolapse is a complete or partial displacement of an organ outside the vagina.
Specialists distinguish several stages of the disease:

• Descent - the uterus descends below the interspinal line and does not come out of the genital slit;
• Incomplete prolapse - the uterus is within the genital slit, and the cervix remains in the small pelvis;
• Complete prolapse - the uterus and the walls of the vagina come out of the genital fissure.

Prolapse of the uterus in old age - causes

• Effects generic activity... Numerous, pathological and multiple births lead to a weakening of muscle tissue, which makes itself felt only during menopause. Weakened muscles that are unable to hold the uterus in an anatomical position and lead to its prolapse.
• Excess weight. Under influence different factors the female body can put on a lot of weight. The extra pounds put a lot of pressure on the pelvic muscles, thereby causing the uterus to prolapse.
• Stool problems. Older women often complain of constipation. Disturbances in the work of the intestines and the strong attempts that accompany them, increase intra-abdominal pressure and contribute to the development of the disease.
• Unhealthy Lifestyle. Long years of hard work, regular overload, unhealthy diet - uterine prolapse is often the result of such unhealthy habits.
• Sports activities involving weight lifting and abdominal muscle tension.
• Hernias and displacement of organs that are located behind the small pelvis.
• Hormonal Disorders.
• Deformation of the pelvic floor resulting from trauma.
• Obstetric manipulations - the use of forceps, manual extraction of the child in breech presentation.
• Congenital malformations of the pelvis.
• Violent and prolonged cough.
• Body features - infantilism, asceticism.
• Heredity.

This video tells about genital prolapse:

Important! The immediate cause of prolapse and prolapse of the uterus is a complex of reasons. One single factor cannot lead to the development of the disease.

Signs of uterine prolapse in older women

Partial or complete prolapse of the uterus in older women can be recognized by the following symptoms:

• Painful discomfort in the genitals and lower back. The pain is aching in nature, increases if a woman sits in one place for a long time, and subsides when the position of the body changes;
• Feeling of a foreign body in the vagina;
• Defecation and urination disorders;
• False urge to urinate;
• Difficulty walking
• Inflammatory processes in the pelvic organs - discharge from the genital tract, cystitis, pyelonephritis, urolithiasis disease etc.
• The development of varicose veins of the lower extremities. It occurs as a result of a violation of blood supply and venous outflow of blood.

Many women do not respond to the symptoms of the disease, numbing the pain with pills and leaving the doctor's visit for later. The result of this delay is the complete prolapse of the uterus, which can only be eliminated by surgery.

Diagnostics

In old age, the disease develops more intensively than in young people. Therefore, it is extremely important to diagnose it on time.
Patients with prolapse of the uterus undergo ultrasound examination of the pelvic organs, colposcopy, smears and cultures to determine the flora of the vagina, proctological and urological examination by specialists.

Drug treatment

Uterine prolapse treatment without surgery involves the use of supportive implants (pessaries or rings) made from bio-inert synthetics and biological material... A pessary inserted into the vagina actually supports the cervix and prevents it from dropping.

This method is used in the early stages of the disease and is considered the most effective. A woman will have to walk with a support ring for the rest of her life, because muscle self-healing in old age is almost impossible.
When wearing the implant, you need to douche with disinfectant solutions every day and adhere to the rules of personal hygiene. At night, the ring must be removed and disinfected. Otherwise, inflammatory processes may develop. After consultation, the woman will be able to remove the pessary on her own.

What else to do when the uterus prolapses in old age? At the first stages, drug therapy is practiced, which can only be prescribed by a doctor. These are mainly drugs with a high dosage of female sex hormones (estrogens), as well as hormonal ointments that are injected into the vagina.

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How effective is a pessary in uterine prolapse? Patient reviews indicate that this device is able to solve complex health problems. To date, there is no cure for prolapse as such; with such an ailment, only surgery can help. Doctors of all countries unanimously argue that a patient diagnosed with prolapse can only be saved by surgery. The search for other treatment options is ongoing, if earlier such an operation threatened to traumatize soft tissues, today medicine has gone far ahead, it has become more technologically advanced and of high quality. A ring in case of prolapse of the uterus is a real salvation, in the event that a woman does not want to resort to a radical method - surgery.

The pessary will replace surgery

The operating method for prolapse of the uterus is the most the best option therapy for young girls. For older women, this method is not entirely suitable, since the operation may be impossible due to other diseases, often women of Balzac's age themselves do not dare to resort to surgical intervention and choose conservative types of therapy for omission.

Today, the pessary is an innovative invention in the treatment of prolapse.

When can you install?

• Urinary incontinence, uterine problems, in the absence of other pathologies.
• Reluctance to perform surgery.
• When uterine defects can be healed without surgery.
• When you need to see the results of the operation, in this case the pessary allows you to adequately assess the effectiveness of treatment.
• During the diagnosis of urinary incontinence.

When the pessary cannot be installed

1. Cancer of the uterus or precancerous condition.
2. Uterine bleeding.
3. Genital infection.
4. Inflammatory process.

Ladies who have a violent sex life are also not advised to use a pessary if they cannot properly install it on their own. If you do not wear it all the time, the result of such treatment will not bear fruit, since it must be used constantly.

What is a pessary and what types of it exist

A pessary is a kind of ring made of high quality silicone or polypropylene.
The shapes and sizes of this device are very diverse, therefore it will not be difficult to pick it up. Here are the most basic forms and types:

1. Supportive, it does not let the vagina go down, it supports it.
2. Thin ring, fixed directly on the cervix.
3. Thick ring.
4. A cup-shaped pessary with a special perforation is used to remove the secretion of the gonads.
5. Cubic device type.
6. The filling ring prevents the prolapse of the uterus.
7. Mushroom type.

Which type is better

The choice of a ring for the vagina must be made by a doctor, the size, and also the shape must absolutely correspond anatomical features vagina, therefore, only the attending physician is able to assess all these factors.

With the fourth degree of prolapse, it is better to use a bowl-shaped device; with a levator, it is used if the patient also has urinary incontinence.

You should be aware that this device can be different, some can be constantly worn, and some should be removed daily and treated with genitals. It is very difficult to master the correct use and introduction of this device on your own, and if you do not have experience, it is recommended to visit your doctor as often as possible, who will clear the genital tract himself. In general, the use of this method of treatment is considered convenient and safe, with it women can lead a fulfilling life. Due to its unsurpassed versatility, this method of therapy solves many gynecological problems in women.

The advantages of this treatment method

As with any treatment, the use of the device has its pros and cons.

pros

• Effective therapy of the disease.
• Warns premature birth and helps to maintain pregnancy.
• With any degree of prolapse of the uterus, this device helps perfectly and the feedback from the patients confirms this.
• Does not cause allergies.
• Safe method.
• Excellent alternative to surgery.
• There are no risks of damage to the uterine cavity.

Minuses

• It is used as an additional treatment for prolapse.
• It causes an unpleasant feeling of discomfort.
• Bacterial vaginosis may develop, but this is not always the case.
• The selection increases.
• May fall out due to incorrect installation.

How is the procedure

The first installation takes place without fail by a gynecologist in an outpatient clinic. Then the woman must learn to install it herself. Before this, it is necessary to undergo a complete examination for the possible identification of inflammatory processes or infectious diseases. Before the introduction of this item, it is sterilized or rinsed in boiling water. For easier administration, petroleum jelly is usually used.

The device is inserted in a horizontal position, during this process it is compressed and installed as deep as possible into the vagina so that the convex part is turned towards the cervix.

With this manipulation, if the patient is correctly selected and installed the ring, the woman should not feel soreness or discomfort.

Naturally, you need to get used to everything and at first there will be a feeling of a foreign object in the body, but then the girl will not remember this element at all.

After installing this element, the girl should visit the gynecologist every two weeks for two months. This is necessary in order for the doctor to make sure that this device is in the normal position and that it will not lead to other complications. The average life of the ring is about six months, but it all depends on the stage of prolapse. If the device is not intended for permanent use, then it must be treated with an antiseptic before each introduction into the vagina, this is very important!

One way or another, but if you have a disease such as prolapse, you should definitely try the rings first, and then if they do not help you, then it is recommended to have an operation. In any case, such a disease cannot be ignored. Feedback from patients using this method of therapy suggests that the treatment gives excellent results.

If you do not deal with this problem, it can lead to other irreparable consequences, therefore it is recommended to undergo therapy in a timely manner, to be tested.

And if possible, take tests every six months and visit a gynecologist in order to identify an ailment at an early stage and prevent its further development. Every woman must give birth, and with such a disease as prolapse, the chances of pregnancy are reduced to zero. Doctors all over the world claim that this method of therapy can increase the chances of being able to safely carry and give birth to a child.