An Ancient Treatment That Still Works: Pessaries for Stress Urinary Incontinence
Stress urinary incontinence (SUI) is so common in women at midlife and beyond that it is one of the first symptoms of aging that women mention. Stress incontinence is the leakage of urine only during certain activities that place stress on the bladder, such as coughing, sneezing, and running. Recommendations by the NIH have emphasized that nonsurgical methods can be quite effective in treating SUI, and thus should be tried before surgery.
One of the oldest treatments for SUI is the pessary. This is a device placed in the vagina that lifts and supports the urethra so that urine does not leak. It is also used for prolapse of the uterus. Another type of treatment for SUI is known as behavioral therapy in which the patient trains the bladder in progressive steps. Although we know that both of these work to treat SUI in some patients, there have been no studies comparing how effective each is over the long term and as short term treatment. Until now.
Such a study was recently reported at the American Urogynecologic Society 30th Annual
Scientific Meeting by the principal investigator, Dr. Holly Richter. In this study, 446 women from ten medical centers in the US were randomized to receive either a pessary, or behavioral therapy, or both. Outcomes were based on the patient’s assessment as to how much her symptoms had improved; these assessments were made at three months and twelve months after the start of therapy.
In the short term (after three months), behavioral therapy was found to result in greater patient satisfaction than the pessary. However, at twelve months, there was no difference between the two therapies in terms of patient satisfaction. In addition, combined therapy was not superior to either of the therapies individually in the short term or the long term.
Therefore, based on this study, it is safe to say that both therapies work in certain patients. Some women prefer behavioral therapy to wearing a pessary, while others are comfortable with the pessary. Not mentioned in this study is the fact that weight loss often greatly relieves the symptoms of SUI.
If you are experiencing SUI, be sure to talk to your clinician about the various nonsurgical methods that are effective in treating it before you consider surgery. And, when discussing these nonsurgical methods, try to assess which type of therapy you would be more comfortable with based on your own preferences.
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