There are a few types of ring pessaries - those with and without support, and those with knob for concomitant stress urinary incontinence. This article explores the key differences, sizing options and fitting considerations for each.
Standard ring pessaries are generally a first-line pessary for clinicians, due to ease of insertion and removal. These are indicated for stage I and II (mild) prolapse, but can be successful for all stages.[2]
A pessary for when the standard ring is not providing enough support. The Ring with Support offers a greater surface area with a flexible membrane featuring drainage holes spanning across the centre of the ring.[3]
Designed for a woman with both pelvic organ prolapse and stress urinary incontinence (SUI) and can also be useful when new symptoms of stress incontinence develop when the patients prolapse is reduced with an initial trial of a pessary without knob. [1] The knob sits under the urethra, supporting the bladder neck to reduce the symptoms of SUI.
Indicated for women with mild to moderate prolapse and stress urinary incontinence who need additional support.
Sizing and fitting a pessary requires careful assessment by a clinician, of both vaginal width and length, as well as an understanding of how different pessary types interact with an individual woman’s anatomy, prolapse characteristics and symptoms.
Successful fitting often involves trialling several diameters. It is important to note that ring pessaries differ in sizing logic from other types of pessary which may also require consideration of vaginal length and stem choice.
Ultimately patient comfort and prolapse support sufficient to reduce symptom and discomfort is the aim. General rule of thumb is to allow for a finger breadth around the outer circumference of the pessary.
Available in sizes 0-10 (44-127 mm)
Explore available sizes, purchase online, or learn more about the product here.
Available in sizes 0-10 (44-127 mm)
Explore available sizes, purchase online, or learn more about the product here.
Available in sizes 0-10 (44-127 mm)
Please note – the additional nodule of the ring with knob adds an additional 13mm and may impact size selection.
Explore available sizes, purchase online, or learn more about the product here.
Available in sizes 0-10 (44-127 mm)
Explore available sizes, purchase online, or learn more about the product here.
Pessary use is part of a shared decision‑making process and can be continued long‑term if effective and well tolerated, enabling many women to maintain normal daily activities with reduced prolapse symptoms.
The Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) guidelines emphasise the importance of assessing fit and symptom relief during the initial fitting and during scheduled reviews, and adjusting size or type if necessary to achieve optimal comfort and retention. [1]
Silicone folding ring pessaries are pliable and fold at designated notches, making insertion and removal easier, particularly for women who self-manage or have reduced manual dexterity. Compared with vinyl pessaries, silicone pessaries are generally easier to insert and remove. Once positioned above the pubic symphysis, the pessary unfolds into its functional shape.[2]
A ring with knob should be inserted like a standard ring but with the knob to one side and then rotated in the vagina so that the knob sits behind the symphysis pubis.
To remove a ring pessary, an index finger should be hooked around the anterior leading edge and used to bring the pessary down to the introitus. Once it reaches the introitus, it should be compressed as much as possible and gently eased out of the vagina.[3]
Ring pessaries can be removed and cleaned and may be managed either by the patient or a healthcare provider. [1]
Pessary self-management refers to women being supported to remove and insert their pessary themselves for management of a pelvic organ prolapse. Women who are self-managing their pessary may still contact the pessary clinic or their GP for support in case of any problems or concerns. [4]
Traditionally, women attending routine pessary care with a healthcare professional are reviewed approximately every six months. Women who self-manage their pessaries may be reviewed annually.[3]
Silicone ring pessaries are available from Mediplus in a variety of sizes.
These are more pliable than the PVC pessaries and as they can fold, are often easier to insert and remove so are useful for a woman who is self-managing.
Silicone pessaries are more expensive to buy but can be washed and re-inserted on many occasions. [1]
Women with mild to moderate prolapse (stage I and II) and/or stress urinary incontinence are good candidates for ring pessaries [1].
Sexual activity is possible with the pessary in place as the vaginal space is not filled by the device although either partner may find sexual intercourse uncomfortable and may wish to remove it before sex. [1]
Index finger should be hooked around the anterior leading edge of the pessary to bring it down to the introitus it should then be compressed and very gently eased out of the vagina. [1]
Wash the pessary in warm water. If you wish, you may use a mild non perfumed soap although this is not usually necessary unless you menstruate. If you are not immediately putting the pessary back in, you may store it in any clean and dry container.
Anaesthesia
Gynaecology
Operating Room
Urology