Abstract

Background: Placement or fitting of a ring pessary is one of the treatment options for women with pelvic organ prolapse (POP), resulting from avulsion. To determine the effect of ring pessary use in these women, usually qualitative measures like a patient experience questionnaire is used. However, quantitative functional information could provide additional information about the state of the pelvic floor muscles, such as the puborectal muscle (PRM).

Methods: In this proof-of-concept study, we describe ultrasound (US) strain imaging of PRM to provide functional information. We acquired three-dimensional (3D) US data in women with avulsion, before and after pessary fitting, and subsequently, their strain patterns have been compared. Normalized strain ratios (NSRs) have been calculated for these women to quantitatively indicate the changes in the state of the PRM at maximum contraction, before as well as three months after pessary use.

Results: Before pessary fitting, the strain ratio was elevated with respect to strain ratios found in women without an avulsion. After pessary fitting, we found that the strain ratio decreased to values close to strain ratios found in women with no avulsion, indicating the benefit of pessary placement. Furthermore, the success of the pessary treatment, as indicated by the NSRs was also reflected in the patient-reported outcome measures (PROMs) from these women.

Conclusions: Since, NSRs decreased to more normal values for these women, from before to after pessary treatment, this ratio could be used as an quantitative indicator for the effectiveness of pessary treatment.