From the Guidelines
Pessary valves are a viable option for managing female urinary incontinence, particularly for women who cannot or prefer not to undergo surgery, and should be considered after first-line treatments such as pelvic floor muscle training and bladder training have been attempted or deemed unsuitable. When considering the use of a pessary valve, it is essential to follow the recommendations for nonsurgical management of urinary incontinence in women, as outlined by the American College of Physicians 1. The ACP recommends first-line treatment with pelvic floor muscle training in women with stress UI, and bladder training in women with urgency UI, with the combination of both for mixed UI 1. Pessary valves work by mechanically supporting the urethra and bladder neck, preventing the downward movement that occurs during increased abdominal pressure, thus maintaining urethral closure pressure and preventing leakage. Key considerations for the use of pessary valves include:
- Proper sizing and fitting by a healthcare provider experienced in pelvic floor disorders
- Regular follow-up appointments to check for complications and ensure proper fit
- Patient education on removal, cleaning, and reinsertion of the pessary
- Management of common side effects such as vaginal discharge, odor, and discomfort, potentially with vaginal estrogen cream in postmenopausal women. Given the strong recommendation for pelvic floor muscle training and bladder training as first-line treatments, pessary valves should be considered as part of a comprehensive approach to managing female urinary incontinence, taking into account the individual patient's needs, preferences, and response to initial treatments 1.
From the Research
Female Incontinence with Pessary Valve
- Female urinary incontinence is a common condition that can affect women of all ages, with a wide range of severity and nature 2.
- The two main types of urinary incontinence are Stress Urinary Incontinence (SUI) and Urge Urinary Incontinence (UUI), with SUI being the result of weak urethral muscle and support, and UUI being the result of an overactive bladder muscle 2.
- A pessary is a device that can be used to treat SUI, and it is typically used in conjunction with behavioral modification and pelvic floor physiotherapy 2, 3.
- The use of a pessary has been shown to be effective in improving symptoms of SUI, with a high satisfaction rate and minimal complications 3, 4.
- The diagnosis of female urinary incontinence typically involves a history and physical examination, including a vaginal exam and measuring postvoidal residual volume, as well as ruling out a urinary tract infection 2.
- Treatment options for female urinary incontinence include behavioral modification, pelvic floor physiotherapy, devices such as a pessary or urethral insert, and surgery, with the choice of treatment depending on the severity and type of incontinence, as well as the individual's preferences and needs 2, 5.
- Vaginal pessaries have been shown to be a cost-effective intervention for treating pelvic organ prolapse and SUI, with a high degree of certainty that they are cost-effective in a population with pelvic organ prolapse, and a moderate degree of certainty in a population with SUI 6.
- Patient preferences and values play an important role in the treatment of female urinary incontinence, with many patients reporting that pessaries relieve most or all of their symptoms and allow them to return to their normal daily activities 6.