Levator Ani Muscle Avulsion Is a Risk Factor for Vaginal Pessary Expulsion

Abstract

Pelvic organ prolapse (POP) is a highly prevalent condition; vaginal pessary is a common treatment for this condition. A recent randomized controlled trial and prospective studies have confirmed the efficacy of vaginal pessary as treatment for this condition. However, expulsion of vaginal pessary remains a major issue. The reported rate of pessary expulsion has been around 30-60%. Several risk factors were known to be associated with unsuccessful pessary fitting namely short vaginal length and wide vaginal introitus. Levator ani muscle (LAM) avulsion is known to be associated with POP. It is also related to symptoms of prolapse and surgical outcome of prolapse repair. The association between successful vaginal pessary use and pelvic floor muscle and hiatal dimensions were examined. LAM avulsion was associated with 3 times higher risk of pessary expulsion in one year. More severe staging of prolapse also increased the risk of expulsion. Pessary expulsion is usually occurs within 2 weeks after insertion, but it can also happen within 6 months.