Posterior compartment prolapse and perineal descent: systematic review of available support devices

ObjectiveThe aim of our study is to systematically review the literature about available devices facilitating perineal support during defecation in patients with obstructive defecation syndrome (ODS) and posterior pelvic organ prolapse (POP).MethodsWe searched for the terms defecat/ion or ODS and pessar/ies or device/aid/tool/perineal/perianal/prolapse and support in MEDLINE, PubMed and Web of Science. Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines. A two-stage inclusion was performed, selecting first on title and abstract and secondly the full text. For variables with sufficient data, a meta-analysis was performed using a random-effects model. Other variables were descriptively reported.ResultsTen studies out of 1332 were included for systematic review. The devices could be categorized into three groups: pessaries (n = 8), vaginal stent (n = 1) and external support device (n = 1). Methodology and data reporting is heterogeneous. Meta-analysis could be performed for the Colorectal-Anal Distress Inventory (CRADI-8) and Impact Questionnaire (CRAI-Q-7) in three pessary studies which showed a significant mean change. Significant improvement of stool evacuation was seen in two other pessary studies. The vaginal stent significantly decreases ODS. Subjective perception of constipation improved significantly using the posterior perineal support device.ConclusionAll reviewed devices seem to improve ODS in patients with POP. There are no data on their efficacy with regard to perineal descent-associated ODS. There is a lack of comparative studies between devices. Studies are difficult to compare due to different inclusion criteria and evaluation tools.

Automated summary

The objective of this study is to review available devices for perineal support during defecation in patients with obstructive defecation syndrome (ODS) and posterior pelvic organ prolapse (POP). A total of 10 studies were included for review. The devices can be categorized into three groups: pessaries, vaginal stent, and external support device. The meta-analysis showed that the pessaries significantly improved Colorectal-Anal Distress Inventory (CRADI-8) and Impact Questionnaire (CRAI-Q-7), while the vaginal stent decreased ODS significantly.