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Quality of Life in Women Who Use Pessaries for Longer Than 12 Months

Tenfelde, Sandi PhD, RN, APN*; Tell, Dina PhD*; Thomas, Tonya Nicole MD; Kenton, Kimberly MD, MS

Female Pelvic Medicine & Reconstructive Surgery: May/June 2015 - Volume 21 - Issue 3 - p 146–149
doi: 10.1097/SPV.0000000000000154
Original Articles
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Objectives Pessaries are an effective treatment for pelvic organ prolapse and urinary incontinence; however, few data exist describing long-term pessary use. Our aim was to describe symptom bother and quality of life (QoL) in women using pessaries for urinary incontinence and/or prolapse for at least 12 months.

Methods Consecutive women who met inclusion criteria were approached for this observational cross-sectional study. Wilson and Cleary’s Health-Related Quality of Life Model guided the inclusion of biologic, functional, and individual factors that impact the health-related QoL. Consenting participants completed a generalized QoL index, the Center for Epidemiologic Depression Symptoms, Medical Outcomes Study Social Support Survey, and condition-specific measures; the Pelvic Floor Distress Inventory (PFDI-20-SF) and the Pelvic Floor Impact Questionnaire.

Results Fifty-six women, mean age 74.4 years (range, 47–89 years), completed the survey. Mean length of time for pessary use was 4.5 years (1–15 years). Most of the women (n = 31, 55.4%) returned to the clinic for pessary care every 3 months. There was no difference in generalized QoL nor condition-specific total PFDI-20 in women performing self-care versus routine follow-up. Almost one third (29%) of participants reported complications related to pessary use (eg, vaginal erosion), and 41%were considering surgical repair in the near future. Women who were considering surgery had higher PFDI-20 scores relating to more bothersome prolapse symptoms than those not considering surgery (Pelvic Organ Prolapse Distress Inventory 6, 33.91 vs 24.73, P = 0.03).

Conclusions Pessaries can be used to control pelvic floor symptoms for extended periods. Complication rates in this study were lower than previously reported, even in women not doing self-care. Not surprisingly, women considering surgical intervention reported greater symptom bother despite pessary use.

Pessaries are an effective treatment for pelvic organ prolapse and urinary incontinence, however, few data exist describing long term pessary use. The findings from this study indicate that long term pessary users generally are happy with pessaries and symptoms control.

From the *Loyola University Chicago, Marcella Niehoff School of Nursing; †Department of Obstetrics and Gynecology, Loyola University Chicago, Stritch School of Medicine, Maywood; and ‡Department of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.

Reprints: Sandi Tenfelde, PhD, RN, APN, Loyola University Chicago, Marcella Niehoff School of Nursing, 2160 South First Ave, 105-2840, Maywood, IL 60153. E-mail: stenfelde@luc.edu.

The authors have declared they have no conflicts of interest.

Supported by Loyola University Chicago School of Nursing Research Stimulation Fund through the Palmer Foundation and research assistance from Sarah DePassa and Jacqueline Garreau.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.