Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence

Abstract

With the aging population in the United States, there has been a renewed interest in pessaries as a conservative alternative to surgical repair for pelvic organ prolapse (POP). They present a good option for patients who have not completed childbearing, do not desire surgery, or are poor surgical candidates. Long-term pessary use is a safe and effective option for patients with POP and stress urinary incontinence. Although serious side effects are infrequent, insertion and removal of most pessary types still pose a challenge for many patients. Pessary design should continue to improve, making its use a more attractive option.

Pelvic organ prolapse (POP) is an important and common medical condition. By age 80, women in the United States have an 11% lifetime risk of undergoing surgery for prolapse or incontinence,1 with a 30% risk of reoperation over a period of 4 years.2 The United States Census Bureau projects that the number of women in America aged ≥ 65 years will double to over 40 million by the year 2030.3 With the aging United States population, there has been a renewed interest in the use of pessaries. A survey distributed to members of the American Urogynecologic Society indicated that 77% of respondents used pessaries as their first-line therapy for POP.4 As treatment options for prolapse and incontinence continue to evolve, the pessary remains a practical alternative.

The use of pessaries dates back as early as the 5th century BCE, during the time of Hippocrates, when hot oil stimulants, astringent-soaked plugs, and pomegranates were used to treat prolapse.5 There has been some advancement in pessaries over the centuries, which are now generally composed of silicone. Despite numerous technological breakthroughs in the medical field over recent decades, pessaries have remained essentially unchanged throughout the 20th century.6