Vaginal Pessaries could be an Adjunct to Standard Care and PFMT for Treating Postpartum UI

A recent study compared three conservative treatment options for postpartum urinary incontinence (UI) – standard care, pelvic floor muscle training (PFMT), and vaginal pessaries, in a generalizable cohort.

In this multicenter, open-label, parallel-group, pragmatic randomized controlled trial, conducted across six outpatient clinics, standard care, PFMT, and vaginal cube pessary for postpartum UI were compared. The sample size calculation was based on large treatment effects (Cramer’s V > 0.35), with 44 participants needed for 80% power and an alpha of 0.05 for a 3 × 3 contingency table. 

The results showed that out of the 516 women screened, 111 had postpartum UI, while 52 were randomized into three groups – standard care (n = 17), PFMT (n = 17), and vaginal cube pessary (n = 18). It was observed that after 12 weeks, patient satisfaction was significantly higher in the vaginal pessary group (77.8%) compared to standard care (41.2%) and PFMT (23.5%; χ2 2,n = 52 = 14.55;Cramer-V = 0.374). No adverse events were reported. Further, stress UI and mixed UI accounted for 88.4% of postpartum UI cases.

The findings suggested that vaginal pessaries were more effective than standard care or PFMT in reducing postpartum UI symptoms, with no reported complications. After 12 weeks, women treated with vaginal pessaries reported significantly higher satisfaction compared to those receiving standard care or PFMT. The low loss-to-follow-up and safety of all treatments are reassuring for patients and practitioners. Further studies are needed to confirm these findings and explore combined therapy approaches. It was inferred that vaginal pessaries could be a valid treatment option for postpartum UI, alongside standard care and PFMT.

Source: Lange S, Lange R, Tabibi E, et al. Geburtshilfe und Frauenheilkunde. 2024 Mar;84(03):246-55.