Cochrane for Clinicians
Putting Evidence into Practice
Pessaries for Managing Pelvic Organ Prolapse in Women
Am Fam Physician. 2021 Jun 1;103(11):660-661.
Author disclosure: No relevant financial affiliations.
Are pessaries effective in treating pelvic organ prolapse in women?
Pessaries combined with pelvic floor muscle training (PFMT) probably improve pelvic organ prolapse symptoms in women (number needed to treat [NNT] = 3; 95% CI, 2 to 6) and prolapse-specific quality of life compared with PFMT alone. However, the risk of adverse events (abnormal vaginal bleeding) may be higher (number needed to harm [NNH] = 27; 95% CI, 5 to 111).1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)
Pelvic organ prolapse is characterized by pelvic organs such as the uterus, bladder, or bowel protruding into the vagina because of pelvic floor muscle weakness. Common symptoms include a feeling of “something coming down,” vaginal or pelvic pain, urinary and/or bowel symptoms, and sexual difficulties, and these can significantly worsen patient quality of life.2 About 40% of women older than 40 years are affected,3 and the prevalence is expected to increase as the population ages. Treatment options include pessaries, PFMT, and surgery. Clinicians commonly offer pessaries as first-line treatment. The authors of this review aimed to determine the effect of pessaries in the management of pelvic organ prolapse.
This Cochrane review included four randomized controlled trials involving 478 women with a mean age of 30.4 to 65.6 years at various stages of prolapse and follow-up ranging from six weeks to two years.1 One trial compared the use of a pessary with no intervention, the second compared a pessary and PFMT, the third compared pessary and surgery, and the fourth trial compared pessary plus PFMT with PFMT alone. Improvement of prolapse symptoms was measured using the validated Pelvic Floor Disability Index or the Pelvic Organ Prolapse Symptom Score. Prolapse-specific quality of life was measured using the Pelvic Floor Impact Questionnaire (PFIQ), with lower scores representing improved quality
Referencesshow all references
1. Bugge C, Adams EJ, Gopinath D, et al. Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database Syst Rev. 2020;(11):CD004010....
2. Jelovsek JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol. 2006;194(5):1455–1461.
3. Hendrix SL, Clark A, Nygaard I, et al. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–1166.
4. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline [NG123]. Updated June 24, 2019. Accessed December 20, 2020. https://www.nice.org.uk/guidance/ng123
5. Pelvic organ prolapse: ACOG practice bulletin no. 214. Obstet Gynecol. 2019;134(5):e126–e142.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.
A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.
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