Skip to main content

20.10.2018 | Original Article

Defecatory dysfunction and other clinical variables are predictors of pessary discontinuation

International Urogynecology Journal
Erin G. Dengler, Louisa A. Mounsey, Francesca Gines, Manahil Agha, Terri Long, Elizabeth J. Geller
Wichtige Hinweise
This research was presented as a poster presentation at the Society of Gynecologic Surgeons 44th annual scientific meeting from 11–14 March 2018 in Orlando, FL, USA and an oral presentation at the International Urogynecology Association 43rd annual scientific meeting 27–20 June 2018 in Vienna, Austria.
A comment to this article is available online at https://​doi.​org/​10.​1007/​s00192-018-03860-2.


Introduction and hypothesis

Pessaries provide first-line therapy for women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The primary hypothesis was that defecatory dysfunction was associated with pessary discontinuation.


This was a retrospective cohort study of all women undergoing first pessary placement at one academic center from April 2014 to January 2017. Defecatory dysfunction was defined as the presence of constipation, rectal straining, rectal splinting, and/or incomplete defecation. Pessary discontinuation was defined as <1 year of pessary use and not using one at the most recent visit. Descriptive statistics; Person’s chi-square, Fisher’s exact, and Student’s t test, and multivariate logistic regression analysis were used where appropriate.


Charts of 1092 women were reviewed and 1071 were included. Mean age was 62 ± 15 years, mean body mass index (BMI) 28 ± 6 kg/m2, and mean parity 2 ± 1; 68% were Caucasian, 73% were menopausal, and 41% were sexually active. Reason for pessary use included POP (46%), SUI (24%), or both (30%). Overall pessary discontinuation rate was 77%; overall rate of defecatory dysfunction was 45%. In a logistic regression model, defecatory dysfunction in the form of incomplete defecation remained significantly associated with pessary discontinuation [odds ratio (OR) 3.29, 95% confidence interval (CI) 1.43–7.52]. Absence of bulge symptoms (OR 2.18, 95% CI 1.22–3.90), and younger age (OR 1.02, 95% CI 1.02–1.05) also remained significantly associated with pessary discontinuation.


Pessary discontinuation was common, and defecatory dysfunction in the form of incomplete defecation had the strongest association with discontinuation. Understanding predictive factors of pessary discontinuation may help guide clinicians and patients when choosing treatment options for pelvic floor dysfunction.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf

Weitere Produktempfehlungen anzeigen
Über diesen Artikel
  1. Sie können e.Med Gynäkologie & Urologie 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Gynäkologie und bleiben Sie gut informiert – ganz bequem per eMail.