PROSPECTIVE EVALUATION OF PELVIC FLOOR SYMPTOMS IN WOMEN UNDERGOING CONSERVATIVE TREATMENT FOR PELVIC ORGAN PROLAPSE

P.K.Tulikangas,¹ T. Lee,² C. Mellen¹, P. Davis,¹ D.M. O’Sullivan,¹ C.A. LaSala,¹

¹Hartford Hospital, Hartford, CT;  ²MaGee Women’s Hospital, Pittsburgh, PA

OBJECTIVE:  Evaluation of women before and after placement of a vaginal pessary to determine the effectiveness of vaginal pessaries in relieving pelvic floor symptoms.

MATERIALS AND METHODS:  Patients who presented to our practice with symptoms of pelvic organ prolapse were offered a trial of a vaginal pessary.  If patients chose to try a vaginal pessary they were invited to participate in this study.  Women enrolled in the study completed the 46 question Pelvic Floor Distress Inventory Survey (PFDIS) prior to pessary placement, two weeks after pessary placement and three months after pessary placement.  At the initial visit, demographic variables, medical history and a pelvic examination with prolapse staging conforming to the ICS terminology were recorded.  Patients’ symptoms before and after placement of the pessary were compared using the McNemar’s chi-square test; values at p<0.05 were considered statistically significant.

RESULTS:  Fifty-nine women were enrolled in the study and completed the baseline questionnaire.  Thirty-six women (61%) were still wearing a pessary at the two-week follow-up and completed the symptom questionnaire.  16 women were still wearing a pessary at the three-month follow-up and completed the symptom questionnaire.  Women who were using a pessary at the two-week follow-up had a significant improvement in their symptoms of feeling a bulge from the vagina [X 2 (1)= 5.82, p<0.02], noticing a protrusion from the vagina [X 2 (1)= 5.82, p<0.02], having to assume an unusual position to urinate [X 2 (1)= 4.17, p<0.04] , and experiencing leakage related to lifting or bending over [X 2 (1)= 4.17, p<0.04].   There were no differences in symptom relief at two weeks compared with three months, although small numbers may not have afforded sufficient power.  None of the patients reported more severe symptoms of pelvic distress after placement of the pessary.

CONCLUSIONS:  Vaginal pessaries are effective at relieving some urinary and prolpase symptoms in women with pelvic organ prolapse.  This information will be helpful when counseling patients about treatments for pelvic organ prolapse.

Key Words:  pelvic organ prolapse, cystocele, rectocele, pessary

Disclosure - Speakers Bureau: P.K. Tulikangas, Pfizer; CA LaSala, Pfizer.