Application:The ring pessary consists of flexible silicone comfortable for the patient with a specific steel spring filling, which keeps the form. It is elastic and can be easily changed by the patient herself. The circumference of the ring is relatively thin. Preferably slight problems of descensus and mild cases of incontinence are treated by the ring pessary. An intact pelvic floor (also if reduced) is required for this pessary. In addition, it can prevent the development of a stress incontinence by its suburethral supporting effect.
Sizes: Various sizes of the ring pessary can be adapted, ranging from minimum 50mm to maximum 100mm. The pessary with the smallest diameter that just holds should be prescribed.
Use: The physician adapts the pessary on the first examination including tests like coughing, pressing and movements. For the insertion the pessary is covered with estrogen cream. After the test, the position of the pessary should be checked again. The pessary can be changed easily by the patient herself, i.e. she has to remove it in the evening and to insert it in the morning. The coating with estrcgen cream facilitates the insertion and improves the local blood circulation as well as the formation of epithelium and connective tissue. Exclusively creams containing estriol (shorter adhesion to the receptor) should be used. Since one needs a relatively small amount of cream (small surface) for the gliding effect, we recommend to use a higher dispensed estriol containing 1 mg estriol/1 g salve. The change of the pessary may be done while standing whereby the patient may put one foot on a stool or the edge of a
bed, in a position comparable to the insertion of a tampon; if this is too difficult, it may be sufficient to insert the pessary while spreading the legs, if necessary while leaning against a wall or while lying. The patient should be trained how to insert the pessary (e.g. first to press it and then push it to the upper part of the vagina) and how to remove it (surrounding of the ring with her forefinger, edging and loosening of the pessary). However, older patients prefer a changing by the physician or a nurse at about 4 to 12 weeks intervals. Under these conditions, one should insert an estriol cream or ovulum once a week.Also if surgery is planned in the long term, the ring, in combination with local estrogens, can be used as a ..preparation before the operation". When inserting the pessary, the patient should verify that the ring is pressed together and inserted into the upper vaginal vault. When removing the pessary, the patient has to take the ring with her forefinger.
Side Effects/Complications: The therapy with this pessary is meant - in combination with additional measures (physiotherapy, estrogens), to cure or at least to reduce the patient's problems caused by prolapse.. The daily change by the patient or the change by the physician and/or nursing staff at about every 4 weeks with local estrogen therapy avoids complications like infections, bleedings or even ulcers. The fixation of a pulling thread may be helpful. If the prolapse is insufficiently cured or if various sizes do not stay in their position one has to to change to a cube pessary and local estrogen therapy. Contraindications for estriol creams should be considered (e.g. pregnancy, lactation period, estrogen-dependent tumors). If the patient is not able to change the pessary by herself, it may be advisable to integrate a nurse or a member of the family into the procedures.
Advice: The product should only be used by one patient and can be stored by room temperature. The pessary may be cleaned under warm running water without using any disinfectant.