None, D. S. H. M., None, D. A. S. D., None, D. A. H. P., None, D. V., None, D. P., None, D. R., None, D. M., None, M. M. N. & None, M. N. (2025). Patient Profile and Clinical Outcomes in Pessary Management for Pelvic organ prolapse. Journal of Contemporary Clinical Practice, 11(12), 111-117.
MLA
None, Dr Shivamurthy H M, et al. "Patient Profile and Clinical Outcomes in Pessary Management for Pelvic organ prolapse." Journal of Contemporary Clinical Practice 11.12 (2025): 111-117.
Chicago
None, Dr Shivamurthy H M, Dr Arshiya Sultana Deshmukh , Dr Ashwini H Pai , Dr Veena , Dr Priyanka , Dr Rashmi , Dr Madhu , Mr Manju Naik and Mr Naveen . "Patient Profile and Clinical Outcomes in Pessary Management for Pelvic organ prolapse." Journal of Contemporary Clinical Practice 11, no. 12 (2025): 111-117.
Harvard
None, D. S. H. M., None, D. A. S. D., None, D. A. H. P., None, D. V., None, D. P., None, D. R., None, D. M., None, M. M. N. and None, M. N. (2025) 'Patient Profile and Clinical Outcomes in Pessary Management for Pelvic organ prolapse' Journal of Contemporary Clinical Practice 11(12), pp. 111-117.
Vancouver
Dr Shivamurthy H M DSHM, Dr Arshiya Sultana Deshmukh DASD, Dr Ashwini H Pai DAHP, Dr Veena DV, Dr Priyanka DP, Dr Rashmi DR, Dr Madhu DM, Mr Manju Naik MMN, Mr Naveen MN. Patient Profile and Clinical Outcomes in Pessary Management for Pelvic organ prolapse. Journal of Contemporary Clinical Practice. 2025 Dec;11(12):111-117.
Background: Uterine prolapse is a frequently encountered gynecological disorder that may present in women of varying age groups. Pelvic organ prolapse is common condition leading to urogenital tract dysfunction and diminished quality of life. As the population ages, the number of women affected with POP is expected to rise approximately 9.2 million by 20501. The prevalence ranges from 3% to 50%, it causes sensation of vaginal bulge, urinary, bowel or sexual dysfunction2. POP affects 50% parous women above 50 years. Risk factors include advanced age, vaginal childbirth especially big baby, obesity, chronic constipation, heavy lifting, smoking. connective tissue disorders3. Prolapse has been shown to negatively affect the quality of life in approximately 60% of affected women4. 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 prolapse5. Pessaries as the initial management strategy for women seeking nonsurgical treatment, those wishing to preserve fertility, individuals with early-stage prolapse, or patients considered unfit for operative procedures. Pessaries may also benefit women with stress urinary incontinence exacerbated by physical exertion 6. Pessaries are minimally invasive silicone devices that have been the cornerstone of the non-surgical management of POP, in addition to pelvic floor muscle exercises. Most studies includes pessaries made up of Silicone and are ring type with or without central support, Gell horn and Doughnut pessary7. Though surgery is permanent management, Vaginal pessary is temporary method of management of uterine prolapse for those who are not fit or willing for surgery due to some reason. Pessary are removable devices inserted into vagina holds the pelvic organs back in their usual place and reduces prolapse. Pessary treatment is minimally invasive, but causes side effects like pain, discomfort, excessive discharge, associated with discontinuition of use in 24% to 49% of women in 12-24 months8. Factors associated with pessary failure are younger age, higher BMI, history of prolapse surgery, short vaginal length or advanced stage of prolapse9. Objectives: To retrospectively analyze the demographic profile of women who underwent pessary treatment, To evaluate problems following insertion, reasons for removal and patient satisfaction in relation to quality of life. Methodology: This observational study was conducted from January 2023 to December 2024. A total of 36 clients undergoing pessary treatment were included. We looked into demographic profile, size of pessary used, follow-up for any difficulties, reasons for removal of pessary and factors influencing client satisfaction. Results: The mean age of participants was 59 years (Range 21 - 85 years). The majority of clients (27.8 %) were in age 71 - 80 years age group, Most clients were multiparous with 41.7 % having parity 4. High parity (>4) observed in 22.2 %. Most cleints presented with third degree prolapse (61.1%) and 11.1 % with procedentia. Among the 36 patients studied, the most frequent type of prolapse was uterovaginal prolapse involving both cystocele and rectocele (44.4%), followed by uterine prolapse with cystocele alone (33.3%) and uterine prolapse with rectocele alone (22.2%). Majority (31, 86.2%) had a history of vaginal delivery, of which 20 (55.6%) were complicated vaginal deliveries, including prolonged or instrumental labor, and 11 (30.6%) were uncomplicated vaginal deliveries. Only 5 patients (13.8%) had undergone LSCS. The main reason for conservative management were co morbidities and advanced age (33.3 % each), followed by fear to undergo surgery (27.8%). The 3.5 inch pessary was most frequently used (44.4%). At 6 months followup, 50% clients reported no difficulty. Common complications include urinary and bowel difficulties (33.3%), dyspareunia (5.6%) and 11.1% required pessary removal. Overall satisfaction was favourable with 89% cleints rating their experience >/=6 on 10 point scale, while 11% opted for removal for low satisfaction. Conclusion: Pessary treatment stands out to be a good option in all health setups for those who are not fit or not willing for surgery for short term duration of few years irrespective of age group. However this people must be under supervision for periodic followup for any adverse outcomes. Category- Department of obstetrics and gynaecology.
Keywords
Pessary
Ring pessary
Conservative management of prolapse
Non- Surgical management of prolapse
INTRODUCTION
Uterine prolapse is a frequently encountered
gynecological disorder that may present in women of varying age groups. Pelvic organ prolapse is common condition leading to urogenital tract dysfunction and diminished quality of life. As the
population ages, the number of women affected with POP is expected to rise approximately 9.2 million by 20501.
The prevalence ranges from 3% to 50%, it causes sensation of vaginal bulge, urinary, bowel or sexual dysfunction2. POP affects 50% parous women above 50 years. Risk factors include advanced age, vaginal childbirth especially big baby,obesity, chronic constipation, heavy lifting, smoking. connective tissue disorders3. Prolapse has been shown to negatively affect the quality of life in approximately 60% of affected women4.
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 prolapse5. Pessaries as the initial management strategy for women seeking nonsurgical treatment, those wishing to preserve fertility, individuals with early-stage prolapse, or patients considered unfit for operative procedures. Pessaries may also benefit
women with stress urinary incontinence exacerbated by physical exertion 6. Pessaries are minimally invasive silicone devices that have been the cornerstone of the non-surgical management of POP, in addition to pelvic floor muscle exercises. Most studies includes pessaries made up of Silicone and are ring type with or without central support, Gell horn and Doughnut pessary7.
Though surgery is permanent management, Vaginal pessary is temporary method of management of uterine prolapse for those who are not fit or willing for surgery due to some reason. Pessary are removable devices inserted into vagina holds the pelvic organs back in their usual place and reduces prolapse. Pessary treatment is minimally invasive, but causes side effects like pain, discomfort, excessive discharge, associated with discontinuition of use in 24% to 49% of women in 12-24 months 8 . Factors associated with pessary failure are younger age, higher BMI, history of prolapse surgery, short vaginal length or advanced stage of prolapse9.
Need for Study: In developing nations, where the burden of this condition is particularly high, it often remains under-recognized and under-treated. Though surgical management remain the mainstay for this condition. However many subjects are unfit for surgery due to various reasons like Co-morbidity, elderly age, fear of surgery. For such subjects ,pessary management will be definitely a good alternative clinical management and affordable. However this people must be under supervision by periodic follow up for any adverse outcome.
METHODS (TYPE OF STUDY)
This observational study was conducted from January 2023 to December 2024 . A total of 36 clients undergoing pessary treatment were included, We looked into demographic profile, size of pessary used, follow-up for any difficulties, reasons for removal of pessary and factors influencing client satisfaction
MATERIAL AND METHODS
Source of data: Department of Obstetrics and Gynaecology, Subbaiah Institute of Medical
Sciences, Shivamogga
Study Design: observational study
Period of collection of data: January 2023 to December 2024
.
Data collected included age, parity, Mode of delivery, Indication for pessary use, size of pessary used, grades of prolapse, follow-up for any difficulties, reasons for removal of pessary and factors influencing client satisfaction
RESULTS
Table 1: Age Distribution
Age (Years) Frequency
21 - 30 01 2.78%
31 - 40 02 5.56%
41 - 50 09 25.00%
51 -60 08 22.22%
61 -70 03 8.33%
71 - 80 10 27.78%
81 - 85 03 8.33%
Total 36
The mean age in our study is found to be 59 years with majority of patients in age group 71-80 years
Table 2: Parity
Parity Number Percentage
1 01 2.78%
2 02 5.56%
3 14 38.89%
>/=4 19 52.78%
In this study, common parity found to be >/=4 in 52.78% women
Table 3: Degree of Prolapse
Degree of Prolapse Frequency Percentage
II 09 25.0%
III 22 61.1%
Procedentia 5 13.9%
Most patients found to have to third degree prolapse 61.1%
Table 4: Type of prolapse
Type of Prolapse Frequency Percentage
Uterovaginal prolapse with cystocele and rectocele 16 44.4%
Uterine prolapse with Cystocele 12 33.3%
Uterine prolapse with Rectocele 8 22.2%s
Most common type noted is Uterovaginal prolapse with both cystocele and rectocele (44.4%). These findings suggest that multi-compartment prolapse is mores prevalent than isolated single-compartment prolapse in this study
Table 5: Mode of Delivery
Mode of Delivery
Frequency Percentage
Vaginal delivery 31 86.1 %
Complicated vaginal delivery
(Instrumental deliveries like forceps or vacuum, or prolonged second stage) 20 55.6%
Uncomplicated vaginal delivery 11 30.6%
VBAC 05 13.8%
Among the 36 patients studied, the majority (31, 86.2%) had history of vaginal delivery, of which
20 (55.6%) were complicated vaginal deliveries, including prolonged or instrumental labor, and
11 (30.6%) uncomplicated vaginal deliveries. Only 5 patients (13.8%) had undergone VBAC
Table 6: Reason for conservative management
Reasons for conservative management Frequency Percentage
Advanced age 16 44.44%
Associated medical comorbidities 13 36.11%
Fear of Surgery 5 13.89%
Desire to preserve fertility 2 5.56%
Most common reason for conservative management found to be Advanced age (44.44%)
Table 7: Size OF Pessary used
Size of the pessary in mm (inches ) Numbers Percentage
75mm (3) 14 38.89%
85mm (3.5 ) 16 44.44%
100mm (4) 06 16.67%
Most common size of pessary used are 85mm (44.4%)
Table 8: Problems noticed during follow up 6 Months
Problems Frequency Percentage
Pessary expulsion 5 20.83%
Vaginal Discharge 3 12.50%
Discomfort 4 16.67%
Dyspareunia 3 12.50%
Vaginal Erosion 4 16.67%
Lost for follow up 5 20.83%
Common problems noticed during followup are Pessary Falling Out (20.83%), Discomfort (16.67%), Vaginal Erosion (16.67%), Dyspareunia in younger age group (12.50%). Among all these 3 (8.33%) cases opted for removal of pessary.
TABLE 9: SATISFACTION ON SCORE
SATISFACTION ON
SCORE OF 10 Frequency % Remarkss
BELOW 6 3 9.68% Poor satisfaction
6 - 8 17 54.84% Moderate satisfaction
8 -10 11 35.48% High satisfaction
DISCUSSION
Conservative management of prolapse have been an accepted choice of management among those patients who are unfit for surgery or not willing for surgery.
In our study we had mean age of 59 years where as study of Yang et al. 10 average age found to be 67.8 years which signifies that prolapse is commonly found in elderly age.
As parity is definitely has a influencing role in causing prolapse. We had about 41.7 % cases having parity 4and High parity (>4) observed in 22.2 % where as in study of Joseph et al.11 noticed parity of >5 times in 22.3% cases.
The conservative management is more suited for Grade-2 and Grade-3 prolapse. In our study we had 61.1% cases with third degree prolapse, where as in Joseph N et al. study. Majority were cases of third-degree prolapse 76.8 %.
Vaginal delivery common mode of delivery in cases with prolapse. Our study had (86.1 %) cases of vaginal delivery which is in agreement with results of other studies. Commonly ring pessary were used where as study of Marianne koch et al. has used different types of pesary like ring pessarey, shell pessary and cube pessary.
Size of pessary is individualized based on the patient's body habitus and clinical presentation. However we found 85mm size pessary fitted in majority where as Ying Zhou et al. has used 70 mm as maximum size and Marianne koch et al. has used 65 mm as maximum size.This discrepancy in optimal pessary sizing across studies may reflect population-specific anatomical variations, differences in fitting protocols, or regional preferences in device availability. The predominance of 85 mm fittings in our study suggests a need to reconsider upper sizing limits, particularly in populations with larger vaginal introitus dimensions or advanced prolapse stages.In this study during follow up after 6 months. While 32.5% of individuals reported no difficulty post-procedure, a significant proportion experienced complications ranging from urinary and bowel issues to vaginal erosion and dyspareunia. Comparing with other studies of Marianne koch et al. 51 % had difficulty like pessary use tiredness (10%),Self change not possible(1%), erosion, bleeding, pain(2%) and Xu , Hainan et al.
Erosions-24.4%, Urinaryproblems-2%,
defaecation difficulty in 1.5% cases. These findings highlight the importance of thorough pre-procedure counseling and proper follow-up to address emerging concerns and improve patient outcomes. Patient satisfaction will be the main aim of any mode of management and for assessing the effectiveness of services and identifying areas for improvement. In our study found to have overall satisfaction for quality of life is favourable 89% rating the scale more than 6.
Remaining 11 % opted for removal due to low satisfaction. Therefore its needed to emphasize on follow-up surveys or interviews to understand specific difficulty noticed after pessary insertion.
CONCLUSION
The demographic profile stresses the need for individualized treatment planning, considering age, parity, and comorbidities. Emphasize on patient education, regular follow-up, and early identification of adverse effects to optimize long-term success and minimize discontinuation rates.
Pessary treatment stands out to be a valuable non-surgical option in all health setups for those who are not unfit or not willing for surgery or aiming for conservative management irrespective of age group.However this people must be under supervision for periodic followup for any adverse outcomes.
Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.
Concept and design: Dr Shivamurthy H M, Dr Arshiya Sultana Deshmukh,Dr Ashwini pai,Dr Veena, Dr Priyanka, Dr Rashmi
Acquisition, analysis, or interpretation of data: Dr Shivamurthy H M, Dr Arshiya Sultana Deshmukh,Dr Ashwini pai,Dr Veena , Dr Priyanka, Dr Rashmi
Drafting of the manuscript: Dr Arshiya, Dr Priyanka, Dr Rashmi
Critical review of the manuscript for important intellectual content: Dr Shivamurthy HM, Dr Ashwini pai,Dr Veena
Supervision: Dr Shivamurthy H M.
Disclosures
Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Ethical Committee of Subbaiah Institute of Medical Sciences (IEC-SUIMS) issued approval IEC-SUIMS/12/2024-25.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Acknowledgements We extend our gratitude to the medical director, Dr. Nagendra S; the executive director, Dr. Latha R. Telang; the dean, Dr. Vinayaka G; and the principal, Dr. Siddalingappa CM, of Subbaiah Institute of Medical Sciences
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