Pessary placement and management

Female pelvic organ prolapse is a common and aggravating condition that few women openly discuss. Fortunately, nonsurgical and surgical treatment options exist for this condition. Nonsurgical treatments include pessaries, which are used to reduce prolapse. The type of pessary depends on the direction and extent or grade of the protruding organ. The use of vaginal pessaries for urinary stress continence is a relatively new treatment option. Proper fit that is determined by trial is essential for effectiveness. Nurses at all levels now need to be familiar with the use of the vaginal pessary for pelvic organ prolapse and urinary stress incontinence. Nurses' roles regarding pessary use need to be clearly defined. Continence nurses should be familiar with the indications for pessary use, the types available for incontinence, and patient education regarding pessary care. Home health and long-term care nurses are frequently asked to periodically remove and insert pessaries. Skills and tips for making removal and insertion as easy as possible need to be disseminated. Advance practice nurses need skills for assessment of prolapse, fitting, and current outpatient pessary care routines. Increasing nurses' understanding of and comfort with pessary use might make a significant difference in the treatment of pelvic organ prolapse and urinary stress incontinence.