Cases
A 98 year-old female from a nursing home, presented with recurrent symptomatic rectal prolapse after a Delorme’s procedure seven months prior. Her past medical history includes Alzheimer’s disease and vascular dementia, hypertension, hypercholesterolaemia, congenital cardiac failure, paroxysmal atrial fibrillation, osteoporosis and recurrent falls.
Despite being considered for abdominal rectopexy, urogynaecology review was sought for second opinion. There was no vaginal prolapse on examination. An oval vaginal pessary was trialled (Figure 1). She is currently on vaginal estrogen cream twice per week with a plan to change the pessary every 2-3 months. Eight months later, the patient continues to comfortably open her bowels without rectal prolapse or vaginal discharge or bleeding.
The second patient is a 78 year-old woman who presented with severe rectal pain, recurrent rectal prolapse, constipation and associated urinary retention.
Past medical history included a Delorme’s procedure 3 years ago, anterior vaginal wall repair, refractory chronic idiopathic thrombocytopenia purpura secondary to splenectomy, degenerative spinal disease with canal stenosis and neuropathy requiring laminectomy and spinal fusion, dyslipidaemia, asthma, Grave’s disease, osteoporosis, osteoarthritis and recurrent falls.
On examination, the patient had a 4cm rectal prolapse outside the anal verge, without a vaginal prolapse. A size 4 Sayco oval pessary with support was fitted. Four months after placement, the patient reported good bowel motions, nil rectal prolapse recurrence, nil urinary retention and nil vaginal discharge or bleeding.
The third patient is a 93 year-old woman who presented with recurrence of her rectal prolapse following a Delorme’s procedure two years ago. Her rectal prolapse did not recur since pessary insertion 6 months ago.