Self-managing pessaries cause fewer issues in women with pelvic organ prolapse

Self-management of a pessary to treat pelvic organ prolapse in women leads to fewer complications and could save the NHS money, research has shown.

The study at Glasgow Caledonian University’s School of Health and Life Sciences’ Research Centre for Health (ReaCH) was funded by the National Institute for Health and Care Research (NIHR).

Pelvic organ prolapse is a common condition which is uncomfortable and can be very painful for women.

A pessary is a prosthetic device administered to women with pelvic organ prolapse, holding the organs in place.

In the UK, most women attend clinics for their care and have to return every six months for check-ups.

Lead researchers in the study said self-managing a pessary has a number of benefits.

The six-year study, Treatment of Prolapse with Self-Care Pessary (TOPSY), examined 340 women of all ages from across the UK.

Researchers said the results could change the lives of thousands of women.

Professor Carol Bugge said: “This research is great news for women in the UK who suffer from prolapse because it shows that women can safely self-manage their pessary from home.

“No matter their age, they may experience fewer complications and there will be less cost to the NHS in the long run by freeing up appointments.

“Pessaries are a very commonly used treatment in the NHS and the mainstay of treatment is that women have to return to clinics roughly every six months, which can be inconvenient and costly.

“This is why we have been looking into self-management for women. Our belief is that by giving the control of their health back to the women it would make their quality of life better.

“We are reaching out to women and healthcare professionals who provide pessary care with these results, so they can see that self-management is a valid option for them.

“It offers safety, it doesn’t worsen their quality of life, there are fewer complications, and for services, it costs less and it frees appointments.”

Professor Suzanne Hagen said: “This was a very large unique trial and the first in its field. We have really made an excellent contribution to the evidence for prolapse management.

“It was a fully powered trial with enough participants involved to give us robust answers. It was also diverse in terms of the age ranges of the women involved and their geographical location within the UK.”

Maria Caulfield, minister for the women’s health strategy, described the findings as “an important step for women to manage their ongoing care for pelvic organ prolapse in the comfort of their own homes”.

She added: “It means women can continue to live their lives as usual and reduces the need for frequent visits to see clinicians.”

Researchers hope self-management can be rolled out UK-wide, but say more research is needed to identify how it can be made routine practice.

Prof Bugge, who began the study when working at the University of Stirling, said: “We have created materials that help train health professionals in self-management. Practitioners need to have the skills to teach patients how to self-manage and that’s why we need more research to look into how best to make this happen on a larger scale.”

Margaret Graham, 63, from Ayrshire, who has been using a pessary for 10 years for prolapse and was a patient representative in the study, said she was “impressed and amazed” at the rigour and care of the research.

She said: “It’s so important that women are presented and supported with as many options as possible for what can be nearly another half of their lives.

“I was really delighted when I was presented with the option of a pessary for this condition.

“I was gobsmacked that this simple silicone donut-shaped thing worked. I thought the only option was surgery and it was terrifying.

“The results of this study could really change thousands of women’s lives if a self-management programme was rolled out because it’s safer, has less complications and stops the need to attend clinics as often.”

The research paper – Clinical effectiveness of vaginal pessary self‐management versus clinic-based care for pelvic organ prolapse (TOPSY): a randomised controlled superiority trial – has been published in The Lancet eClinicalMedicine journal.