Rockledge, Florida

Marja Sprock, M.D., FACOG, FPMRS Board Certified
Fellowship Trained Urogynecologist

Now Accepting New Patients      Phone:  321-806-3929

Recently Published

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Accidental Bowel Loss - A Socially Hidden Problem

Nerve Stimulation to Treat Urinary and Fecal Problems

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Pessary Treatment of Prolapse

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Accidental Bowel Loss or Fecal Incontinence

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Previously Published by Category








Technical & Educational Info

All Published Articles

Pessary Treatment of Prolapse
By Marja Sprock, M.D. FACOG, FPMRS Board Certified

A pessary is a support or space filling device which can be placed in the vagina in case of descend or prolapse of the organs. Pelvic organ prolapse (POP) of the bladder, uterus, top of the vagina after hysterectomy (cuff) or small bowel can be supported by a pessary. They are usually not very effective in case of weakness of the vaginal/rectal wall (rectocele).

POP occurs when there is lack of adequate tissue and muscle support of the pelvic floor. The bladder is most commonly involved, but uterus, cervix, vagina, small bowel, urethra or rectum can all be part of POP.

A lot of women may have some POP, however are not bothered by it. Pregnancy, labor and childbirth may result in POP as well as advancing age, genetic predisposition, obesity, constipation and connective tissue disorders.

Repair of vaginal prolapse, has been scrutinized recently and numerous patients are unsure about what to do. Some have chosen to stay away from a healthcare provider, since they feel that there is no good decision to be made.

Surgery is an option when organs start protruding through the vagina, possibly causing back pain, pressure, difficulty urinating, night time urination, sitting on an egg feeling, ulcerations, bleeding, difficulty evacuating bowel movements and difficulty with sexual relations.

Surgery can be performed vaginally or through the abdomen with a laparoscope or robot. When using a laparoscope or robot a mesh is usually used; through the vagina it can be repaired with or without a mesh. A prolapse repair with permanent and/or non-permanent stitches has a higher failure rate than if a mesh is used. The FDA has released several reports and warnings of potential side effects with the use of a mesh. The mesh will possibly be re-qualified as a high-risk device. This as opposed to the sling for stress urinary incontinence (SUI) which will remain a low-to moderate risk device. Several companies are performing after market studies and we already have several studies in the literature showing the superiority of some meshes over others. Usually the lower weight, the lower density, the more chance there is for natural ingrowth of tissue, leading to a stronger repair.

The FDA states that all surgical procedures have risks. Also there are risks with medical implants. A mesh is permanent, a pessary temporary and can be removed. In fact a pessary needs to be cleaned and reinserted on a regular basis. A pessary however can keep organs in place, without having to go through a surgery. A ring pessary which makes people think of a diaphragm, can be removed before intercourse or left in; a space occupying pessary like a Gellhorn can’t be easily removed or left in for sexual encounters. A pessary like a Gellhorn gives great support to a severely prolapsed vagina, however needs professional cleaning and reinsertion at least once every 3 months. If a pessary is left in place for too long, it will create discharge and could produce pressure ulcers.

Pessaries, think of them as support shelves in the vagina, need to be fitted. If the POP is inside the vagina and not protruding like an egg or ball, the ring pessary can usually provide support, unless there are very weak muscles. A Gellhorn or space occupying pessary is usually successful for the more severe prolapse. Some women are very pleased with their pessary and will use this for years, others do not like to have a shelf, which is prone to the formation of discharge, in the vagina.

Non-surgical options for POP are pessary and pelvic floor muscle training. Pelvic floor muscle training is crucial for vaginal health, no matter which solution for prolapse will be chosen. It is difficult to walk without using your leg muscles; there is lack of vaginal support without strengthening you pelvic floor muscles. Remember there is no surgery involved in strengthening your pelvic floor muscles, just some effort and time. It can be done at home after proper instruction or with helpful devices.

Wilma at 66 had enough of feeling it was Easter all year long. There is nothing good about having a bulge coming out of your vagina, providing a constant pressure and egg feeling. Her 89 year old mother Edna had had the same problem and had been very happy with a pessary. Edna did not want to remove, clean and reinsert the pessary herself and had the doctor do it for her. Edna used to get up 4-5 times at night and now gets up once and feels much better. Wilma after reading about all the options and the pro’s and con’s of POP repair, was feeling dazzled. She needed more time, but was done with Easter. Wilma requested a pessary insertion and is sure she eventually desires a surgical repair, however decided to buy some time and still be comfortable. Wilma does not care for the discharge the pessary provokes; her mother barely notices anything with hers. Wilma also likes to be sexually active, which her mother has no interest in anymore.

Remember everybody is different, even the ones with the same genetic predisposition.

Having a pessary fitted is one way of dealing with POP. Make an appointment at Central Florida UroGynecology and we can prevent you from getting dazzled with all the POP options and make sure you and your prolapse get taken care of.

Call 321-806-3929 and schedule an appointment with Katrina Davis, MD or Marja Sprock, MD. or check us out at

"Central Florida UroGynecology where high tech and common sense meet"

Central Florida Urogynecology

101 Eyster Boulevard, Rockledge, FL 32955

Phone 321-806-3929

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updated:  January 11, 2016