I've had a cystocele for several years - but because of some heavy carrying over last winter (a "no, no"), a bout of coughing with respiratory flu (I've now learned to cross my legs and kegel when coughing since coughing is one of the worst things for a cystocele), and the aging process of ligaments loosening (I'm 64), the cystocele went from a Stage 2 to a Stage 3 out of 4.
I debated about surgery even though I had read Christine's original book and truly didn't want surgery (a Surgeon my Gyn sent me to for a pessary fitting was really pushing for the surgery for various reasons) and drove myself crazy (should I? or shouldn't I?) - but finally decided that I would try to manage and not have the surgery. Big decision - since I am very active and involved in much volunteer work and other things, including travelling. I knew that I had to try a pessary because without it, I was uncomfortable and hurting since there was chafing and irritation in the area and it was uncomfortable because it had dropped.
So - about 2 months ago, I decided to get a ring pessary with support, even though pessaries supposedly don't work with a Stage 3 or 4 prolapse.
After much, much, much frustration (and tears - and I am not a "teary" person - or at least I wasn't until now!!), and trying everything to keep that pessary in place (it wasn't working because it would slide down and press on my bladder and then I'd be in the bathroom every 10 minutes!) (I was seriously thinking about writing a guide book to the restrooms in the Malls, restaurants, WalMart, KMart, Home Depot, grocery stores - you get the idea! - and other places in our area), I found an article about pessaries that really has made a HUGE difference.
The article was written by 2 Doctors from Toronto who realized that there is very little instruction given to doctors when they are learning about pessaries, and they decided that they would make pessary use an important part of their practices. The article, published in The College of Family Physicians of Canada monthly newsletter (Mar 2007 Vol 53), is an instructional article for other doctors to teach them how to fit and insert pessaries.
The article states that ring pessaries work best for Stage 1 or 2 prolapses (but I have Stage 3 now) and also work best if the uterus is present and works for cystoceles, urethroceles, uterine prolapse, and stress incontinence.
Obviously, you have to be fairly comfortable with your body to do this (and I think you have to be careful if you have long fingernails), but here is how it works (and it is working for me so far, even though after a lot of walking or standing I may have to go into a bathroom and reposition it):
I squat down and GENTLY use my finger to push the bladder and uterus up into place (the Doctors didn't say to do this, but I found that it works much better because you are starting in the correct organ position). You insert the pessary (whatever method you use to insert it -I find it's easiest to put my one foot up on the commode) GENTLY as far as it will go up, so that it is over the bones in that area. You then turn the pessary 90 degrees (I just move it gently with the tip of my finger), so that you can feel a small hole in the front, rather than the large hole which is in the front when you insert the pessary. Since the pessary can only be folded in one way to insert it, by turning it after you insert it, you stop it from closing back up on its axis and it decreases the chance of expulsion.
IMPORTANT - you have to turn it back to the large hole before you take it out so that it bends.
That's it!! I remove my pessary every night - and if it gets too uncomfortable during the day and I'm home, I just take it out and reinsert it when I'm ready. So far, it is working for me, most of the time. And if I know that I'm going to be sitting for a very long time (such as a trip in the car, or a long movie), I just don't use it during that time so that I'm not sitting on it for hours. I'm trying to control the pessary rather than having the pessary control me.
Granted, sometimes, no matter what you do, wearing the pessary can be uncomfortable. But I think (at least for me) getting used to using a pessary takes time (it's taken me 2 months). I realize that some women just have one inserted by the Doctor and they are comfortable from the beginning. But that didn't happen for me - and if you are having problems with using it, try giving yourself some time to figure out what works best for you. I wanted to be able to insert and remove the pessary by myself. And be sure you have the correct size.
I found it's also MOST IMPORTANT to keep your bowels moving every day. It makes such a big difference in the comfort with the pessary. When your bowels are full, the pessary presses against them and you have discomfort, or the bowels tend to push the pessary down and the cystocele out.
The other problem I had was gas. I have always eaten high fiber cereal in the morning - but I had so much gas and discomfort, I stopped eating it, and the gas stopped. I tried eating it again, and the gas was back. So, instead, I follow Christine's suggestions in her book - I eat two peeled Granny apples every day (they evidentally have more fiber than other apples)- and/or a salad, and I've found that cantelope, a handful of almonds, and raspberries and sweet potatoes help a lot also. Stringy meat such as beef (which I very seldom had eaten anyway), etc., causes constipation for me (although chicken seems to be okay) but I'm trying to eat as little meat as possible and use other sources for protein.
I hope the suggestions about the pessary can help you if you're having problems. I'm certainly not an expert - but I WAS desperate - and this technique seems to be working for me. I hope that I can stablize the Stage 3 and I am trying to do whatever I can to do so (including daily kegels and abdominal breathing). Hope this technique works for you, too!!!