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Pessary offer documentation in women undergoing surgery for pelvic organ prolapse at a tertiary care hospital

13 August 2020
Volume 29 · Issue 15



Women report similar functional outcomes after pessary treatment or surgery for pelvic organ prolapse (POP).


To assess the documentation of pessary counselling in women who underwent surgery for POP. Methods: This was a retrospective cohort study conducted on women who underwent hysterectomy for prolapse. The primary outcome measure was documentation regarding offer of pessary. ‘Pessary offer’ was defined as documentation that clearly stated that the care provider offered pessary to the patient.


Over the study period, 81 hysterectomies took place for POP; pessary offer was documented for only 19 (23.5%) case records. Characteristics significantly associated with pessary offer were history of chronic cough (P=0.031), previous pelvic surgery (P<0.001), no secondary indication for surgery (P=0.012), concomitant surgery performed other than hysterectomy (P=0.046), age range (P<0.001) and BMI range (P<0.001).


Pessary offer was documented in less than quarter of cases. This denotes a need to strengthen documentation of offer, counselling for pessary, or both of these.

Pelvic organ prolapse (POP) is a common condition and affects approximately 50% of women who deliver vaginally (Gyhagen et al, 2013). A feeling of a vaginal bulge is the most commonly reported symptom; however, difficulty in opening bowels, urinary incontinence, backache and sexual pain are also common presenting symptoms (Haylen et al, 2016).

Management options for POP consist of pelvic floor exercises, pessary insertion and surgery. It is customary to offer less invasive options first (Manonai et al, 2018).

A pessary is a device made of silicone or plastic that is placed in the vagina to achieve anatomical correction and reduction of prolapse for symptomatic relief. Once inserted, a pessary remains in situ for 4–6 months and is replaced at follow up provided the recipient has no complications (Lough et al, 2018). The use of a pessary for POP is extremely common, and according to a Cochrane database review, around 77% of physicians offer a pessary as first-line management (Bugge et al, 2013). A pessary is a safe and effective conservative treatment option, relieves almost half of all symptoms and has a beneficial effect on quality of life for affected women (Mao et al, 2018).

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