Cassandra Shaw, MSN'18, and Kathy Trotter, associate professor and Women’s Health Nurse Practitioner lead faculty, contributed to "Pessary Use in Pelvic Organ Prolapse" in "Women's Healthcare Journal" with Michele O’Shea, of Duke OBGYN. 

Introduction

The pelvic floor is a broad group of muscles, primarily composed of the levator ani muscle group. These muscles maintain a constant low level of contraction to support the pelvic organs and tighten the urethral and anal sphincters to maintain continence. Pelvic organ prolapse (POP) occurs when the pelvic floor muscles relax or are damaged and fail to support various pelvic organs. As a result, one or more of the vaginal walls or cervix descend. Cystocele and/or urethrocele occur with anterior vaginal wall prolapse. Rectocele and/or enterocele occur with posterior vaginal wall prolapse. Uterine/cervical prolapse or vaginal vault prolapse after a hysterectomy may also occur.

POP affects approximately 25% of women in the United States.¹ The prevalence of POP increases with age, obesity, chronic constipation, and in those with hysterectomies and greater parity.^1–3 Spontaneous vaginal delivery and trauma of the levator ani muscles associated with operative vaginal delivery increases the risk of POP.^1,4,5

Many women with POP are asymptomatic and do not need treatment. For those who are symptomatic, pessaries are a treatment option and can often provide relief without surgical intervention. Nurse practitioners (NPs) providing women’s healthcare have an important opportunity to evaluate for POP, fit pessaries, provide instructions on use and care, and follow up to promote successful use and prevent any complications. Here, we review the evaluation of POP and management for symptomatic women with a focus on pessaries.