Effectiveness of pessary and pelvic floor physiotherapy alone and in combination for management of stress and mixed urinary incontinence: a literature review

Abstract

: Stress urinary incontinence (SUI) affects 29–75% of women and can have a significant impact on quality of life. Pessaries are low-cost interventions that have been used since the 5th century BC. Pessaries can be used to conservatively manage SUI alone or in combination with other evidence-based conservative treatments, such as pelvic floor physiotherapy. Unfortunately, pessaries have been underutilized and the value of pessaries in the treatment of SUI remains uncertain. Pessary is an effective short-term management option for SUI. Improvement in SUI was noted in 36–66% of patients. Combination of pessary and behavioural therapy is more effective than pessary alone. Behavioural therapy includes pelvic floor physiotherapy and instructions for use of pelvic floor muscles to prevent SUI. For long-term pessary use, results are conflicting. The current evidence is limited by considerable discontinuation and dropout rates. There is a gap in knowledge regarding the effects of long-term pessary and pelvic floor physiotherapy use alone and in combination for treatment of SUI with more frequent clinician contact. Future research would guide clinicians in the value of pessary use and assist in managing patient expectations.