A pessary is a soft, removable medical device, typically made of silicone, inserted into the vagina to provide structural support to pelvic organs. These devices manage symptoms related to pelvic organ prolapse (where organs like the bladder or uterus descend) or help control stress urinary incontinence. While pessaries offer a non-surgical option, their presence in the vaginal canal changes the local environment, which can increase the risk of developing a Urinary Tract Infection (UTI). This risk is manageable through proper care and consistent follow-up.
The Mechanism Linking Pessaries to UTIs
The mechanical presence of the pessary can disrupt the normal function of the lower urinary tract, creating conditions favorable for bacterial growth. A pessary that is slightly too large or improperly fitted may exert pressure on the bladder or urethra, preventing the complete expulsion of urine. This incomplete emptying leads to urinary stasis, where residual urine remains in the bladder after voiding. Stagnant urine provides an ideal environment for bacteria to multiply, increasing the likelihood of infection.
The device also acts as a foreign object that facilitates the movement of bacteria from the perineal area into the urethra. Bacteria, particularly E. coli (the most common cause of UTIs), can migrate along the surface of the pessary toward the urethral opening. Once in the urinary tract, bacteria adhere to the pessary’s surface, forming a protective layer known as a biofilm.
A biofilm is a complex community of microorganisms encased in a self-produced matrix that adheres to the device. This structure shields the bacteria from the immune system and makes them resistant to standard antibiotic treatments. Biofilms, which are often Lactobacillus-deficient, form on nearly all pessaries after continuous long-term use. The presence of this biofilm makes clearing an infection challenging and contributes to the high rate of recurrent UTIs seen in some users.
Minimizing Urinary Tract Infection Risk
Diligent hygiene practices are paramount for mitigating the risk of infection when using a pessary. The device should be removed and cleaned regularly with mild soap and warm water, followed by a thorough rinse. Cleaning frequency depends on the specific device and user preference, ranging from daily removal to bi-weekly cleaning in a healthcare setting.
Adequate fluid intake is an effective strategy, as increased hydration promotes frequent urination, which naturally flushes bacteria out of the urinary tract. This action reduces the concentration of bacteria and limits the time they have to adhere to the bladder wall or device. Mastering voiding techniques can also ensure complete bladder emptying, preventing urinary stasis.
A technique known as double voiding involves urinating normally, waiting 20 to 30 seconds, and attempting to urinate again by leaning slightly forward. This technique, sometimes combined with gently rocking the pelvis, helps empty residual urine trapped by the pessary’s position. For post-menopausal women, local estrogen therapy (often a cream or tablet) can be prescribed to strengthen the vaginal tissue. Estrogen improves the health and integrity of the vaginal lining, reducing irritation and making the tissue less susceptible to bacterial adherence.
If UTI symptoms occur, such as burning during urination, increased frequency, or a persistent urge, contact a healthcare provider promptly. Persistent or severe symptoms require a medical evaluation to confirm the bacterial infection and determine the appropriate treatment.
Other Vaginal and Urinary Side Effects
While a UTI is a concern, pessary use is associated with several other local side effects that are not infectious. An increase in vaginal discharge is common because the body produces more lubrication in response to the presence of a foreign object. This discharge is typically clear or white and does not require treatment unless accompanied by an offensive odor or a change in color.
The alteration of the balance of microorganisms in the vagina can lead to non-UTI infections, such as bacterial vaginosis (BV) or yeast infections. These conditions are characterized by an abnormal discharge and odor, distinct from the classic burning and urgency of a UTI. Local irritation and erosion of the vaginal wall can occur if the pessary is not properly sized or is left in place too long without removal. Signs include discomfort, spotting, or a pinkish-tinged discharge on the device.
Even without a true infection, a poorly fitted pessary can cause difficulty or pain when attempting to empty the bladder or bowels. This non-infectious urinary retention is a mechanical issue due to pressure on the urethra, necessitating immediate removal and refitting of the device. Regular follow-up appointments are necessary to check the fit, assess the vaginal tissue for irritation, and clean the device if the user cannot manage it independently.