Cube Pessary

I live in the US but I think the cube pessary should be available anywhere.  That said, I get the impression that other ones are better if they work.  I think a ring pessary has a lower risk of things going wrong and is much lower maintenance than a cube pessary.  If a ring pessary would have worked for me I would have been very happy to try it. 

The cube pessary has to be removed for sex and also, it seems, for daily cleaning.  I'm leaving it out when I sleep.  It's difficult to remove and mine isn't working very well.  It's interfering with going to the bathroom (which it shouldn't) and I think it's pressing on my intestines.  I called the doctor but they haven't called back yet.

As for symptoms, I don't have any rectal discomfort.  I do have back pain that I think is partially caused by the rectocele but it doesn't hurt to go to the bathroom.

A rectocele is a hernia in the fascia between the vagina and the rectum.  The most noticible problem I have is that the hernia is large enough that when I try to defecate, I have to use my hand to press on the back wall of my vagina so that the intestine doesn't bulge farther into my vagina (a.k.a. splinting).  Before I knewI had a rectocele, shortly after childbirth, I went to the bathroom and when I pushed the intestine actually went through the hernia and out through my vagina.  It was like I had a fleshy pink poo sticking out of my vagina.   It didn't hurt and I pushed it back through, but it was disturbing.  This hasn't happened since then as I splint.   I also have problems with incomplete emptying.  I do get some itchiness and discomfort because when you don't empty, things can leak a bit.  It has never been enough to get on my underwear, just enough that I go to the bathroom and when I wipe, there is something to wipe.  I guess that is still anal incontinence, though.   Back/SI joint pain is my other symptom but I'm not sure how much of that I can blame on the rectocele.  Some, I think.   If I stop and think about it I do have a feeling of heaviness that people often describe, but it is very small compared to the pain so I don't really notice it.

I also have some urinary symptoms, but those are milder and I don't know if I have a cystocele yet.

I've been told my rectocele is large (more than 3cm) but I havent' been told the grade.  The prolapse doesn't protrude from the vagina when I'm not straining (though it can reach the opening and you can see it) but it can protrude when I defecate if I'm not careful so I think it's a pretty severe one.  It's a bit of a mess and I'm expecting surgery is needed but we haven't gotten there yet. .

My urogyn did the pessary fitting. 

I think they should be able to try a different pessary if the ring pessary isn't helping you.  There are a lot of other kinds of pessaries and a different one might well work better, especially if you do have a rectocele as ring pessaries aren't really supposed to help with those.

Per the doctor, I'm not wearing it anymore.  It was interfering with going to the bathroom too much to be considered acceptable.

Ah, sorry to hear it was a problem Dorry.  Did they offer you anything else?  I'm so relieved I've got an appointment for Tuesday to get a pessary fitted again (hopefully!).  I had to go private, otherwise it would have been February to wait until.  But I had a pessary for many years before the surgery that failed, so hoping it will be OK now, although there is also the vaginal vault prolapsed now as well, so it will probably be a different sort.

and thank you for asking, Chris.  I appreciate the concern  

You're welcome Dorry.  Did they give you anything else?  If they didn't, I hope they can help somehow. 

I already had an appointment scheduled, so we're just waiting until then.  I'm not sure there is another pessary option for me unless it is the same pessary in another size.   I think it would need to be smaller so it doesn't block things, but I'm not sure it will stay in if it is smaller.  I don't really know.  My rectocele is quite large and symptomatic.  TBH, I was expecting them to just say from the beginning that we would need surgery and they wouldn't bother to try other things.  

I'm not sure how much it helped with my pain, but it did stop my intestines from bulging through the rectocele and I think that is good.  Now that it is out, I'm noticing the feeling of thins being not right much more than I did before.  I guess I just got used to it, or something.

I hope they can find a good pessary for you!   I think if the rectocele is smaller there are more pessaries that work.  I hope you have more options than I do!  It sounds like it worked well for you before and I hope it will again.

Oh, and I'm also getting pelvic floor physical therapy.  I'm going to try to find out more about the long term plan for fixing things at the next visit.  They are still doing testing to see if other things are going on but that should be done soon.

I hope they can come up with something useful for you Dorry because it's always good to have options.  I THINK the pessary that MIGHT work for me is the ring with the bit in the middle filled in with holes in it.  I just had the ring before.  When they had to take it out a couple of weeks before surgery I noticed the difference hugely, and it's back to that state now, so I know, although there are downsides, if they can fit one I'll be happier for it.  It's just that feeling now that I daren't lift anything, and have to be careful coughing etc.  I'm sure you know all about that too.

Oh that is good Dorry.  They obviously think it will improve things for you.  I've never had anything mentioned re the prolapses and pelvic floor.  The only time that was mentioned was after the repair and the hysterectomy.  Do keep in touch and let us know how it goes:-)  Hope it's good!

Just talking to my husband about pelvic floor exercises and wondering if they'll mention anything when I go on Tuesday (but then they won't if they can fit a ring) but after all the conversations I've had with him about pelvic floor exercises, his response was 'but you can't kneel on the floor because of your knees' thinking that pelvic FLOOR exercises were done on the floor!  Has he listened at all???? LOL!

haha, oh dear.

Ask them about exercises when they are fitting the pessary.  Whether or not it is a good idea depends on what is going on with your body and they should be able to tell that while they are doing the exam.

Oh, one reason I need pelvic floor physical therapy is that my pelvic floor muscles are in spasm.  Right now we are working on relaxing the muscles.  Maybe we'll get to kegels at some point, but right now they just make everything worse.  I'm guessing that operating while I am in spasm could also be a bad idea but that is just a guess.

oh, I found a site on pelvic floor physical therapy that seemed good to me in case you want to read up on what they do.  Search for "canada pelvic floor physical therapy" and it will be the first thing that comes up.

Ah - right, yes, I've read about the muscles being in spasm.  Yes, they say you mustn't do faster pelvic floor exercises if the muscles are in spasm, don't they?  I can't remember very well what I read now.  Yep, I went on to that site and have been doing pelvic floor exercises thick and fast, but it doesn't seem to be helping the prolapse and I did read that nothing will help a vaginal vault prolapse - only a supporting pessary.  I THINK, if you have a pessary, you're not supposed to do pelvic floor exercises, are you?  Again, I THOUGHT I'd read that somewhere, but then you can read all sorts of things on the internet so I'll check that out with the doctor on Tuesday.

I've read you aren't supposed to do any pelvic floor exercises at all if you are in spasm.  I'm just doing breathing/relaxation exercises for my pelvic floor right now.

I don't know anything about pelvic floor exercises and pessaries but definitely ask!  I searched a bit and I think you can still do them but that's just based on a quick search.  

Ah right - yes!  That makes sense re not doing them if you are in spasm!  I must remember to ask about them re the pessary:-) 

Yep - you're right!  I just checked it and they reckon that you should do pelvic floor exercises when you've got a pessary because the pessary actually helps the pelvic floor exercises be more effective. 

Great!  I hope you can get a pessary that fits well and between that and the exercises, you get enough relief.

Thanks Dorry.  The pelvic floor exercises have really been a total education to me because it's not something that was mentioned when I had the pessary ring, but having said that, the ring was so successful that I'm desperately hoping they can fit me with another on Tuesday.  It was only last night it suddenly hit me that when I'd been told the ring had to come out for two weeks prior to the hysterectomy how I missed it so much.  It had done such a brilliant job for years and years and I was uncomfortable without it, and the prolapse is back at that stage now.  I know I'll need something to support the vaginal vault as well, but am hoping the foldable ring that I had that they also do with a centre piece with holes in, will work.  Suddenly I'm feeling a huge relief at the possibility of having a pessary fitted again!  Even if a prolapse isn't dropping below the vaginal entrance, it's still uncomfortable as you sit and walk and bend etc. and although it's not going to kill you, I find it like a constant reminder that it's THERE!  So the support pessary gets my vote and I'm keeping everything crossed that the fact I've had a repair, and the fact I've had a hysterectomy, and the fact there are now three prolapses, rather than two, won't mean they can't fit something.  But I'm hanging on to the fact that they cancer gynie people did ask if I'd like a prolapse pessary again, so I'm hoping that was an informed decision by the registrar and means I'm in with a chance of being suitable!  I will let you know though.  In the meantime I'm not using the key e pessaries or anything because I want the area to be as clear as possible for when they do it.