Priority 13 from the Pessary use for Prolapse PSP

UNCERTAINTY: What is the role of physiotherapy as part of pessary management for prolapse? (JLA PSP Priority 13)
Overall ranking 13
JLA question ID 0054/13
Explanatory note Recent research has indicated that supervised pelvic floor muscle exercises (PFME) are effective in the treatment of prolapse. Specialist physiotherapists teach women how to improve their pelvic floor muscles. Knowing whether the use of a pessary in addition to  PFME would improve the success of the treatment could be a cost effective and simple addition to usual care for women with prolapse. 

The most relevant study is: Hagen S et al (2014) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial

Health Research Classification System category Renal and urogenital
Extra information provided by this PSP
Original uncertainty examples

Does short term use of a pessary aid the conservative recovery from POP. That is, is it possible that using it with PFME may mean not needing it in the future?  ~  Can women achieve better activation of the pelvic floor muscle complex when a pessary is in situ?  ~  is physiotherapy a better first line option than pessaries?

Submitted by 2 x both, 1 x healthcare professional
PSP information
PSP unique ID 0054
PSP name Pessary use for Prolapse
Total number of uncertainties identified by this PSP. 66  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 8 September 2017