Background/Purpose: Women with pelvic organ prolapse (POP) report symptoms, which include urinary incontinence, discomfort in the pelvic floor, and difficulty voiding with bowel and bladder. These symptoms often affect the individual’s ability to participate in physical activities, intimate relationships, and daily activities. Conservative treatments for prolapse include pessary therapy and pelvic floor muscle training (PFMT). Stress urinary incontinence (SUI) often coincides with POP and is treated with either pessary or PFMT as well. The purpose of this article analysis is to determine which treatment is more effective when treating women with POP.
Case Description: The patient described was a 42 year-old woman with a stage II POP. She had a history of two births with mild tearing and chronic constipation. She was experiencing vaginal heaviness sensations, difficulty voiding, and stress urinary incontinence. She was interested in conservative treatment and was hoping to avoid surgery. Her goal was to reduce symptoms and allow her to return to her previous level of physical activity.
Outcomes: In women with POP, pessary therapy was shown to make greater improvements in symptoms and quality of life (QOL) compared to PFMT. For women experiencing SUI, PFMT and behavioral therapy was found to improve SUI symptoms greater than pessary therapy.
Discussion: Pessary use leads to greater improvements of POP symptoms, however, only 60% of women continued their use so women need to be managed throughout their fittings to ensure they find a pessary type and size that works for them. For SUI, PFMT is the best treatment compared to pessary, however improvements only lasted 3 months. More research is needed to examine adherence issues and the mechanism causing SUI so the best treatment option can be selected.
Doctor of Physical Therapy (DPT)
Deborah Doerfler, PT, DPT, PhD, OCS
pelvic organ prolapse, pelvic floor muscle training, pessary, pelvic floor, stres urinary inctontinence
Link, Amy M. SPT. "Pessary Therapy Compared to Pelvic Floor Muscle Training in Women with Pelvic Organ Prolapse." (2018). http://digitalrepository.unm.edu/dpt/135