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Maria, Netherlands

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Before Treatment

I learned a prolapse can affect women’s daily lives in a nasty way. Running, carrying heavy bags or just sitting on your haunches suddenly feels uncomfortable. Through my work with a patient-facing pelvic floor organization, I have a lot of knowledge of the female pelvic floor. Even with all of the knowledge I have, I still tried to ignore the feeling of pressure in my abdomen for years until the moment that I couldn’t take a long walk with my family, and I almost couldn’t pee anymore. A visit to the GP, however embarrassing, turned out to be inevitable. She noted a considerable prolapse and also explained that my urethra became trapped as a result, causing my inability to empty my bladder properly. This is called urinary retention. She suggested a pessary might be a solution.



This initially turned out to be disappointing. The pessary prescribed fell out as soon as I got out of the car at home. After two more visits to the doctor and trying an increasing sized pessary, I still had the same result. At first I thought I will just leave it as it is; I just must learn to live with it. But a few months later the complaints became more and more painful. A referral to the gynecologist followed. Birthing two children of over nine pounds each with a vacuum pump turned out to be the explanation for why the pessary would not stay in place. I was shocked by the explanation about surgery, mainly because of the chance that the complaints could come back. On the gynecologist’s advice I decided to try again to see a pelvic physiotherapist. I had been here twenty years ago during and after my pregnancy, but then the treatment was mainly for my pelvic instability and not so much on training the pelvic floor muscles. The physiotherapist taught me to control and strengthen my pelvic floor muscles, but the prolapse symptoms could not be solved with this. My physiotherapist mentioned another type of pessary in the shape of a cube. This may not be prescribed by a physiotherapist, but a request to the gynecologist led to an appointment with a continence nurse. The cube immediately appeared to provide the grip that the annular pessary could not provide. The secret? The square block, made of silicone, has hollow, ‘dimpled’ walls. This causes the pessary to suction attached to the vaginal wall. Pelvic floor support is then less needed. Once inserted, you do not feel it anymore. Its use is only intended for daytime; in the evening you have to remove the pessary. I compare it with a bra, you do not wear it at night either, but you would not want to miss its support during the day! Insertion and removal can be compared with the procedure for a tampon. There is really only one extra action with the pull out: you hook your finger behind a cube edge, as a result of which air can get in and lift the vacuum.


After Treatment

I can now walk as long as I want. Squatting or emptying my bladder are not a problemanymore. Thanks to the cube pessary and my better trained pelvic floor muscles, the prolapse has not gotten worse. I am very ‘careful’ with my pelvic floor these days. I have replaced running with fast walking (anyway better for your knees) and I avoid heavy lifting. There are still larger sizes of this cube, but I want to delay the use of a larger cube as long as possible. I see this lifestyle as a form of prevention – not to prevent the problem of prolapse, but to make sure it does not get worse. When I recently went back to the GP, I told her about my good experiences with the cube. Surprisingly, she was not yet familiar with this pessary shape. In retrospect, I did worry needlessly for a while, and that’s why I think it’s important to share my experience story.


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