Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse

OBJECTIVE: To prospectively evaluate the effects of vaginal pessaries on symptoms associated with pelvic organ prolapse and identify the risk factors for failure. METHODS: All women referred to a specialist urogynecology unit with symptomatic pelvic organ prolapse who elected to use a pessary were included in this study. All completed the Sheffield pelvic organ prolapse symptom questionnaire before use and after 4 months of use. The primary outcome measure was change of symptoms from baseline to 4 months. RESULTS: Of 203 consecutive women fitted with a pessary, 153 (75%) successfully retained the pessary at 2 weeks, and 97 completed the questionnaires at 4 months. Multivariate logistic regression analysis showed that failure to retain the pessary was significantly associated with increasing parity (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14-2.02, P =.004) and hysterectomy (OR 4.57, 95% CI 1.71-12.25, P =.002). In the success group at 4 months (n = 97), a significant improvement in voiding was reported by 39 participants (40%, P =.001), in urinary urgency by 37 (38%, P =.001), in urge urinary incontinence by 28 (29%, P =.015), in bowel evacuation by 27 (28%, P =.045), in fecal urgency by 22 (23%, P =.018), and in urge fecal incontinence by 19 (20%, P =.027), but there was no significant improvement in stress urinary incontinence in 22 participants (23% P =.275). Of the 26 (27%) who were sexually active, 16 (17%, P =.001) reported an increase in frequency of sexual activity, and 11 (11%, P =.041) had improved in sexual satisfaction. CONCLUSION: A vaginal pessary is an effective and simple method of alleviating symptoms of pelvic organ prolapse and associated pelvic floor dysfunction. Failure to retain the pessary is associated with increasing parity and previous hysterectomy.