The effect of pessary treatment on puborectalis muscle function

Claudia Manzini,Frieda Van Den Noort,Mariëlla I J Withagen,Carl H Van Der Vaart,Anique T M Grob

doi:10.1007/s00192-021-04766-2

Abstract

Introduction and hypothesisThe objective was to assess if puborectalis muscle (PRM) function changes in women with pelvic organ prolapse (POP) undergoing pessary treatment.MethodsThis was a prospective cohort study of women with symptomatic POP choosing pessary treatment. An interview, clinical examination and 3D/4D transperineal ultrasound were performed at baseline and at 3-month follow-up. POP was assessed using the Pelvic Organ Prolapse Quantification system (POPQ). Parameters compared between baseline and follow-up were: hiatal area at rest (HArest), maximal contraction (HActx), and maximal Valsalva maneuver (HAVal), displacement in contraction (DISPL-ctx, i.e., relative difference between HArest and HActx), and displacement in Valsalva (DISPL-Val, i.e., relative difference between and HAVal and HArest). Parameters were compared in women with and those without complete avulsion.ResultsA total of 162 women were assessed and 34 were included. Mean age was 64 years (SD 11.4), and mean BMI 24 kg/m2 (SD 3.1). Thirty-one women had a cystocele, 8 a uterine prolapse, and 12 had a posterior compartment prolapse. Twenty-one women (61.8%) had a POP stage II, and 13 (38.2%) a POP stage III. Ring pessaries were most frequently used (97%). In the entire group a statistically significant increase in DISPL-ctx was observed (mean difference 2.1%, p = 0.017). In the no avulsion group HArest and DISPL-ctx increased significantly (mean difference 4.1%, p = 0.016 and 2.7%, p = 0.016 respectively) and the increase in DISPL-ctx was higher than in the avulsion group (mean difference 2.7% vs 0.2%, p = 0.056).ConclusionOur results show that PRM function changes in women with POP undergoing pessary treatment and suggest that such change occurs mainly in the absence of complete avulsion.

Highlights

Introduction and hypothesisThe objective was to assess if puborectalis muscle (PRM) function changes in women with pelvic organ prolapse (POP) undergoing pessary treatment
The aim of our study is to investigate with transperineal ultrasound (TPUS) if an average of 3 months of pessary treatment is associated with changes in PRM function
The data used in the current study were collected as a subset within the GYNecological Imaging using 3D UltraSound (GYNIUS) project on the assessment of pelvic floor contractility with TPUS, which was conducted at our urogynecological center, where secondary and tertiary care are provided

Summary

Introduction

Introduction and hypothesisThe objective was to assess if puborectalis muscle (PRM) function changes in women with pelvic organ prolapse (POP) undergoing pessary treatment. Int Urogynecol J (2021) 32:1409–1417 teracts the abnormal pressure gradient that has arisen during POP development In this way, the pressure the LAM is exposed to could be reduced and the LAM, or some of its subdivisions (such as the PRM), could partially regain their function as the result of tissue remodeling or a physical effect [13]. Jones and coworkers observed a decrease in genital hiatus size (i.e., GH of the Pelvic Organ Prolapse Quantification system, POPQ) after 3 months of pessary use. They concluded that pessary use may result in some degree of LAM recovery [13]. We analyzed the influence of avulsion on the change in PRM function observed during pessary treatment

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