Pelvic organ prolapse and pessaries, an alternative to surgery

My colleague Jane was performing an incontinence assessment on Mrs H, a housebound woman in her seventies who was having urinary incontinence. During the course of the assessment Mrs H told Jane that she had a prolapsed uterus. When Jane offered to speak with Mrs H's GP about it, Mrs H replied that her GP had said the only thing that could be done was surgery.

Jane knew that a prolapsed uterus could also be managed with a pessary, although she did not know much more than that. She contacted the GP, who said that Mrs H was not a good candidate for surgery. When Jane asked about a pessary, the GP replied that she did not know how to fit them, and neither did the practice nurse. Jane contacted the local bladder and bowel service, but there was no one there who was able to fit Mrs H with a pessary. Eventually Jane discovered that there was a clinical nurse specialist, working within the gynaecology department of a nearby hospital, who fitted patients with pessaries. Jane arranged for Mrs H to have an outpatient appointment with the clinical nurse specialist, including arranging hospital transport and a relative to accompany Mrs H. Mrs H was eventually fitted for a pessary, with advice on managing it and a follow-up appointment. The pessary did not fully reverse Mrs H's incontinence, but it did make it more manageable. It also improved Mrs H's quality of life and helped her feel more comfortable.