Changes in the symptoms and quality of life of women with symptomatic pelvic organ prolapse fitted with a ring with support pessary

Objectives: The study aim was to assess the effect of treatment with a ring with support pessary on bothersome symptoms and the quality of life of patients with symptomatic pelvic organ prolapse (POP). Study design: In this prospective observational study, 142 patients with symptomatic POP were successfully fitted with a ring with support pessary between November 2015 and November 2016 and followed up until December 2017. Prolapse and urinary symptoms were assessed, and the Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) were administered at baseline and at each follow-up visit. Univariate analyses, McNemar's test and paired t-tests were used for data analyses. Main outcome measures: Changes in prolapse and urinary symptoms and quality of life after fitting with a ring with support pessary use. Results: The median (range) duration of follow-up was 17 (13-24) months. At the study endpoint, 98 patients (74.8%) continued to use the pessaries. Wider vaginal introitus (>= 5 cm) was found to be a predictor of pessary discontinuation. Although de novo stress urinary incontinence occurred in 27.1% of patients, almost all prolapse symptoms and most of the concurrent urinary symptoms were resolved, with voiding difficulty resolved most significantly. Scores on both the PFIQ-7 and PFDI-20 had significantly improved at the study endpoint, with changes in scores on the urinary and prolapse sub-scales of both questionnaires demonstrating clinical significance (effect size > 0.5). Conclusions: A ring with support pessary is a safe and effective conservative treatment for POP; it not only relieves bothersome prolapse and urinary symptoms but also significantly decreases their impacts on health related quality of life. However, the method has a limited effect on defecatory symptoms.