In a nutshell
This study looked at the effectiveness of ring pessaries on pelvic organ prolapse (POP) in women. It concluded that ring pessaries are safe and effective.
Pelvic organ prolapse (POP) is a common condition among women. It is most common in those who have given birth and those who are postmenopausal. It involves the descent of pelvic organs outside of the vagina. These organs include: the womb (uterus), bladder, bowel and the inner vagina. Patients with POP often experience a lower quality of life. This is due to urinary symptoms, defecation problems or genital problems.
POP is usually treated with vaginal pessaries or with surgery. Surgery can carry a significant risk of complications. Pessaries are a less invasive POP treatment. Ring pessaries are a type of support pessary used commonly. Ring pessaries are easy to insert and remove. However, they need to be studied for their long term effectiveness in POP treatment.
Methods & findings
142 women were included in this study. These were women with POP. The patients were fitted with a ring pessary. Patients were followed for two years. Patients were monitored at 3, 6 and 12 months after pessary fitting. They were then monitored every six months after that. Vaginal exams were performed at visits. Urinary, rectal (defecation) and prolapse symptoms were assessed through questionnaires at each visit.
At the end of the study, 98 (74.8%) patients were still using the pessaries. Those with vaginas wider than 5cm were at high risk of stopping the pessary. Most patients improved in urinary and prolapse symptoms. Vaginal bulging improved in 93.9% of patients. Pelvic pressure improved in 86.8% of patients. There was no observed improvement in rectal symptoms. Patient satisfaction was high at the end of the study. 33 patients did not continue to use the pessary after the study. The reasons for stopping pessary use included: insufficient symptom relief, pessary not staying inserted, wanting surgery, vaginal bleeding, discomfort, difficulty urinating, stress urinary incontinence, constipation (inability to defecate), difficulty inserting or removing the pessary.
Some complications did occur. 40.8% of patients had vaginal discharge. 23.5% of patients suffered from vaginal erosion (cells from the cervix become exposed to the vagina). Stress urinary incontinence occurred in 27.1% of patients.
The bottom line
This study concluded that ring pessaries are safe and effective in treating urinary symptoms in women with POP. They are also effective in improving quality of life.
The fine print
The authors note that rectal symptoms were not examined properly.
If you are interested in learning more about ring pessaries to treat POP, talk to your doctor.
Published By :
Nov 01, 2018
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