The network of muscles, ligaments and fascia around the vagina, cervix, uterus and adjacent organs is a complex structure that holds the pelvic organs in a normal position so that they retain their mobility during sex, urination, defecation, pregnancy and childbirth. Various components of this support system can become impaired due to trauma and prolonged exposure to elevated intra-abdominal pressure, which can eventually lead to pelvic organ prolapse.
prolapse (omission) pelvic organs is a condition in which organs such as the uterus, rectum, bladder, urethra(urethra), the small intestine or the vagina itself may begin to deviate from their normal position towards the exit of the vagina until they completely fall out (Fig. 1).
Rice. 1. Prolapse of the pelvic organs: prolapsed uterus, anterior wall of the vagina with part Bladder, back wall of the vagina with part of the rectum.
Symptoms that arise as a result pelvic organ prolapse usually affect sexual function, lead to disturbances in my emission and defecation. In addition, women experience a feeling of discomfort, pain, protrusion from the genital slit. All this is often accompanied by significant psycho-emotional disorders.
What are the types of pelvic organ prolapse?
- Rectocele(rectal prolapse). This type of prolapse involves prolapse of the back wall of the vagina (rectovaginal fascia). When this fascia weakens, the rectal wall presses against the vaginal wall, creating a bulge. This thickening may become particularly noticeable during a bowel movement (Fig. 1).
- cystocele(prolapse of the bladder). This can happen when the front wall of the vagina (pubocervical fascia) is torn (usually as a result of childbirth). The bladder exerts pressure on the weakened anterior vaginal wall and causes it to prolapse (Fig. 1). Often this is accompanied by prolapse of the urethra ( urethrocele). Sometimes, with a defect in the pubocervical fascia located under the urethra (suburethral ligament), hypermobility (abnormal mobility) of the urethra occurs, resulting in (leakage of urine during coughing, sneezing, or exercise).
- Enterocele(hernia small intestine). Weakening of the upper (apical) supporting structures of the vagina can cause this type of prolapse. Often this type of prolapse is combined with a rectocele and is called a rectoenterocele (Fig. 2).
Rice. 2. Enterocele
- Uterine prolapse (metrocele). It occurs due to the weakening of a group of ligaments that make up the so-called pericervical ring (sacral-uterine, cardinal ligaments). This leads to prolapse of the uterus, which is usually combined with prolapse of both the anterior and rear walls vagina (Fig. 1).
- Vaginal prolapse (apical prolapse). Is an option enterocele that occurs after (removal of the uterus). Since the uterus provides support for the upper part of the vagina, this operation results in some degree of apical prolapse. AT severe cases the vagina, as it were, turns inside out and protrudes from the genital slit by 10 centimeters or more (Fig. 3).
Rice. 3. Apical prolapse after hysterectomy
What are the degrees of pelvic organ prolapse?
Exists great amount classifications of pelvic organ prolapse. But, in clinical practice more often we use the simple classification presented below (Fig. 4).
- Zero degree of prolapse: the uterus is within the upper third of the vagina.
- First degree prolapse: the uterus is located within the middle third of the vagina.
- The second degree of prolapse: the uterus reaches the exit from the genital gap.
- Third degree prolapse: the uterus protrudes beyond the genital gap, but not 100%.
- Grade 4 prolapse: The entire uterus is outside the vagina. This degree is also called procidentia, or complete prolapse of the uterus.
Rice. 4. Classification of genital prolapse (according to Baden-Walker)
For scientific purposes, among specialists - urogynecologists, of course, more complex, but accurate classifications, such as POP-Q, are also common.
Approximately 30-40% of women have some degree of pelvic organ prolapse during their lifetime, usually after menopause, childbirth, or a hysterectomy. For most women, symptoms of prolapse appear after age 40 and progress more quickly after menopause. Many women who have symptoms of prolapse do not seek medical attention due to embarrassment or other reasons. Some women who have pelvic organ prolapse do not experience any symptoms.
Treatment of pelvic organ prolapse
Undoubtedly, operational method treatment pelvic organ prolapse, which includes many different options for operations, is the most advanced, because. allows you to restore the anatomy and functionality of the genital and adjacent organs in the "original form". However, operations have their own risks associated with anesthesia, surgical complications and relapses of the disease.
Since ancient times, the method of treatment of prolapse of the pelvic organs in women, which has not lost its relevance, is also use of pessaries.
History reference
Before the modern era of operative gynecology pessaries were the only effective treatment option for women with symptoms prolapse of the pelvic organs. Modern gynecologists tend to be skeptical about the use of pessaries and rely mainly on the surgical treatment of this pathology. There is practically no school for teaching the use of pessaries. This attitude could not but be passed on to patients who often underestimate the effectiveness and safety of using pessaries for prolapse of the uterus and vaginal walls. Not the last role in this situation was played by the fact that, until recently, there was no variety of shapes and sizes of pessaries on the Ukrainian market, as well as the methodology for their selection at a gynecologist's appointment.
The pessaries were integral part arsenal for the treatment of pelvic organ prolapse in women for more than a millennium. In the literature there are references to the prolapse of the uterus in papyri ancient egypt dating back to 2000 BC. The oldest surviving medical text on the treatment of genital prolapse is by Soranus (98-138 AD). In his book Diseases of Women, he described methods for treating prolapse, such as hanging a woman upside down for 1 day (Fig. 5).
Rice. 5. Treatment of pelvic organ prolapse by hanging upside down
The second curious method of treatment in those centuries was the use of aromatic substances orally. Doctors of that time believed that the uterus, like an animal, would return inside "smelling" a pleasant smell.
Another technique involved tying a dead rodent or lizard to a prolapsed uterus in the hope of “frightening” the uterus and causing it to “run away” back to its correct position.
These and other utopian therapies were strongly criticized by Soranus. In turn, he suggested tamponing the vagina with woolen tampons soaked in olive oil. After repositioning the uterus with such a tampon, the woman's legs were tied together and she lay for 3 days.
After Soranus, many also suggested various options, which became the prototype of modern pessaries. One of the scientists promoting the use of pessaries was the great French surgeon Ambroa Pare (1510-1590). Pare made oval-shaped vaginal pessaries from brass or wood, waxed and polished.
The prototype of modern pessaries was the products of Hendrik Van Deventer (1651-1724), who substantiated use of pessaries With scientific point vision (Fig. 6).
Rice. 6. Deventer pessaries - prototypes of modern
Modern stage
To date, opportunities have significantly expanded in Ukraine due to the appearance of modern pessaries. various forms and sizes (Fig. 7). Modern silicone pessaries are designed for effective treatment various forms of genital prolapse and urinary incontinence. Pessaries have been used for many years conservative treatment genital prolapse and urinary incontinence. AT last years this method of treatment is experiencing a second youth. The revival of pessaries is due to the fact that modern steel products are made from a special material - medical silicone rubber. The use of elastic, hypoallergenic silicone made it possible to reduce the risk of complications to a minimum and create comfortable and effective types of pessaries for the patient.
Rice. 7. Variety of modern pessaries
Indications for the use of pessaries in modern gynecology:
- Complicated and uncomplicated prolapse of the genitals of varying degrees if:
- the patient does not want to be operated on;
- there are contraindications to surgical treatment (somatic pathology, age);
- it is necessary to delay surgical treatment (decubital ulcer of the cervix, subcompensation for somatic pathology);
- you need to see what effect to expect from the operation, for example, with stress urinary incontinence.
Important points:
- Pessaries are intended for individual use.
- The pessary is supplied non-sterile.
- Disinfection required before use.
- The pessary can be washed with warm tap water using detergents.
- The pessary can be sterilized with steam (134ºC/3.8 bar) or hot air (250ºC).
- The properties of the material allow the product to be repeatedly disinfected. It is not recommended to sterilize pessaries by boiling.
Some facts about modern pessaries
- Older women are more likely to choose pessary treatment over surgery and continue to wear a pessary if successful.
- Up to three-quarters of patients who choose pessaries as a treatment for prolapse have had a successful experience with them.
- Factors that negatively affect the success of the pessary application:
- recurrent prolapse after vaginal surgery
- short vagina
- very wide vaginal opening
- a very significant degree of omission
- Patient satisfaction with the pessary is generally high, but persistence or recurrence often prompts discontinuation in favor of surgery.
- Ring pessaries can be used successfully if the prolapse does not exceed grade III. With IV degree of omission, cubic pessaries are more applicable.
- The most common complications include: vaginal abrasions (bleeding, discomfort), bad breath.
- The current practice of using pessaries varies widely depending on the physician's attitude to the problem.
What are the types of pessaries?
Silicone pessary "ring"
Description: the pessary has the shape of a ring and is provided with an internal elastic element.
Silicone pessary: the ring is supplied in the following sizes (outer diameter) 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 mm.
This pessary model is most often used to correct slight prolapse of the vaginal walls.
Silicone pessary "thick ring"
Description: silicone pessary: thick ring has the shape of a ring.
The product is supplied in the following sizes (outer diameter): 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 mm.
Silicone pessary: a thick ring is used to correct the prolapse of the vaginal walls with mild and medium degree gravity.
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Pessary silicone cup and perforated cup
Description: silicone pessary: cup and silicone pessary: cup perforated has the shape of a bowl with a large central hole. Holes of smaller diameter are made in the cup pessary, perforated along the periphery.
Silicone pessaries: cup and perforated cup are supplied in the following sizes (outer diameter): 55, 60, 65, 70, 75, 80, 85, 90, 95 mm.
Cup pessaries are used in cases of mild to moderate pelvic prolapse.
Pessary silicone urethral
Description: silicone pessary: urethral has the shape of a ring, on the rim of the ring there is a thickening of an oval shape. The thickening is intended for additional fixation of the urethra. The ring is reinforced with an elastic element.
Silicone pessary: urethral comes in the following sizes (outer diameter): 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 mm.
Urethral pessaries are used to treat and correct mild cystoceles.
Pessary silicone cup-urethral
Description: silicone pessary: cup-urethral has the shape of a bowl with an oval thickening and a large central hole. The thickening is intended for additional fixation of the urethra.
Silicone pessary: urethral cup are supplied in the following sizes (outer diameter): 55, 60, 65, 70, 75, 80, 85, 90 mm.
Urethral cup pessaries are used to correct mild to moderate pelvic prolapse moderate degree combined with .
Hodge silicone pessary
Description: Hodge silicone pessary is a ring made of elastic biologically inert silicone reinforced with a deformable element.
Hodge silicone pessary comes in the following sizes: 55, 60, 65, 70, 75, 80, 85, 90, 95 mm.
The design of the pessary allows you to give the product any shape. This allows the use of the Hodge pessary in situations where the anatomical features of the patient do not allow the use of traditional pessaries. The most commonly used pessary is severe degrees prolapse of the walls of the vagina.
Perforated silicone cervical pessary
Description: silicone pessary: perforated cervical has the shape of a deep bowl with a large central hole and numerous holes of smaller diameter along the periphery.
This pessary model is used to correct moderate prolapse of the vaginal walls and to prevent premature birth with a short cervix.
Pessary silicone cube
Description: silicone pessary: cubic and silicone pessary: cubic perforated has the shape of a cube with concave sides. In the model of a silicone cubic perforated pessary, holes are made on the sides for the outflow of the vaginal discharge. For ease of removal, cubic pessaries are equipped with a thread.
Silicone pessary: cubic and cubic perforated available in the following sizes: 25, 29, 32, 37, 41, 45 mm.
Cubic pessaries are used for severe degrees of prolapse. This pessary model is intended for short-term use (no more than 6-12 hours, introduction for the day and removal for the night).
Silicone mushroom pessary
Description: mushroom-shaped pessary has the shape of a bowl on a stem. A thickening is made on the base of the leg. The foot of the pessary is designed to hold it as deep as possible into the vagina.
Silicone Pessary: Mushroom is available in the following sizes (outer diameter): 50, 55, 60, 65, 70, 75, 80, 85, 90 mm.
Treatment with the mushroom pessary is reserved for cases where other types of pessaries have failed. This pessary model is intended for short-term use (no more than 6-12 hours, introduction for the day and removal for the night).
The choice of type and size of pessary depends on anatomical features patient, the severity of the prolapse, and the presence or absence of comorbid disorders urination (Fig. 8).
The size of the pessary is determined based on the results of an objective examination and assessment of the capacity of the vagina using try-on rings (Fig. 9). For treatment, a pessary with the smallest diameter should be used, which eliminates / reduces the manifestations of prolapse. With a correctly selected size of the pessary, a small gap should remain between the product and the vaginal wall (10-15 mm, the width of the finger phalanx). The correctness of the installation should be evaluated with muscle tension abdominals(eg, coughing, straining) and when moving. The pessary should not fall out when straining, cause difficulty in urination and pain into the vagina.
Rice. 9. Choice of pessary size * The most commonly used pessary sizes.
The practice of simultaneous use of two pessaries is described. When using two pessaries (two thick rings of different diameters, urethral + thick ring or other combinations), a combination of supporting and filling effects is achieved. These cases are isolated, but this technique can help in the treatment of complex cases.
The assessment of vaginal capacity using the Cuzco mirror is presented below (Fig. 10)
Rice. 10. Evaluation of vaginal capacity using the Cusco speculum
Duration of continuous use of pessaries
The duration of treatment with a pessary depends on a combination of many factors (the stability of the vaginal microbiocenosis, the degree of estrogen deficiency) and, therefore, is very individual. On average, a patient can use pessaries (except for cubic and mushroom-shaped ones) for 30-40 days.
After the selection and installation of the pessary, a follow-up examination should be recommended after 10-14 days. During the control examination, the effectiveness of treatment and the condition of the vaginal mucosa are evaluated. The next examination is recommended after 30 - 40 days. Cases of successful continuous use of a pessary for more than 6-8 months are described.
It should be remembered and understood! The selection of a pessary is a rather laborious process. Sometimes, even if the doctor takes into account all the features of the anatomy of a particular patient, it becomes necessary to purchase another pessary of a different shape or size. If you do not accept this option - do not seek this kind of help.
Pelvic organ prolapse and accompanying urinary incontinence is a serious medical, social and economic problem. Every third woman aged 45-70 years has a prolapse of the vagina and uterus, expressed to one degree or another. Every 11th patient is operated on for this disease, in a third of cases, doctors have to resort to repeated surgical intervention.
The prolapse and prolapse of the vagina and uterus is characterized by the displacement of these organs down, beyond the genital gap. At the same time, along with the genitals, the bladder and rectum can change their location, which causes a violation of defecation and urinary incontinence.
Depending on the degree of prolapse of the genitals, 4 degrees of prolapse are distinguished. The first, second and even third degree of prolapse are amenable to conservative treatment, including behavioral therapy, diet therapy, perineal muscle training and the use of gynecological (urogynecological) pessaries. Last year, the Ministry of Health of Russia officially recommended the use of uterine and vaginal pessaries in the treatment of pelvic organ prolapse, as highly efficient method preventing further development disease and strengthening pelvic floor.
Recommendations for the use of a gynecological (urogynecological) pessary:
Treatment of genital prolapse of 1-3 degrees;
conservative therapy prolapse of 3-4 degrees in case of refusal from surgical treatment, in case of contraindications to surgery in aged patients with severe comorbidities;
diagnosis of latent urinary incontinence;
treatment of stress urinary incontinence;
predicting results surgical treatment(test with uterine ring).
To date, there are purpose can be divided into two large groups:
Gynecological pessaries, which are designed to solve prolapse problems not complicated by urinary incontinence (ring pessaries and cup pessaries for prolapse of the vagina and uterus);
urethral pessaries (urogynecological) - pessaries recommended for urinary incontinence.
This division is very arbitrary, since gynecological pessaries can solve the problem of stress urinary incontinence, and urethral ones provide quite effective support for the pelvic organs. In this case, we are talking about the prevailing symptoms, in accordance with which one or another model of the pessary is selected.
According to the mechanism of action, gynecological (urogynecological) pessaries are usually divided into:
1. Supportive, that is, fixed on the cervix, thereby providing additional support to the pelvic organs:
Uterine rings or pessary rings;
rings with a levator (urethral pessary);
cup pessaries;
pessaries-strips;
donut-type pessaries.
2. Filling pessaries that fill the vaginal cavity, thereby preventing the prolapse of the uterus, "sagging" of the urethra and rectum:
Donut-type pessaries;
cubic pessaries;
inflatable pessaries;
mushroom pessary.
The selection of a pessary for prolapse of the uterus and vagina is carried out by a doctor after assessing the condition of the female genital organs. For mild prolapse, uterine ring pessaries are usually recommended. With a pronounced omission, they are not used because of the risk of "punching" and infringement of the uterus in the central hole of the pessary. In this case, the choice is made between a cup pessary or a filling pessary, the shape of which is determined by the condition of the pelvic floor and its ability to hold the device in place.
The urethral pessary (for urinary incontinence) has an additional protrusion (levator), which shifts the urethro-vesical angle, provides support for the urethra, increases its length, and reduces bladder hyperactivity.
| Size, mm | vendor code | Size, mm | vendor code |
| 50 | 700/300/050 | 74 | 700/300/074 |
| 53 | 700/300/053 | 77 | 700/300/077 |
| 56 | 700/300/056 | 80 | 700/300/080 |
| 59 | 700/300/059 | 85 | 700/300/085 |
| 62 | 700/300/062 | 90 | 700/300/090 |
| 65 | 700/300/065 | 95 | 700/300/095 |
| 68 | 700/300/068 | 100 | 700/300/100 |
| 71 | 700/300/071 | 110 | 700/300/110 |
Portex uterine rings are made of thermoplastic implantable non-toxic polyvinyl chloride (under the influence of body temperature, the ring becomes softer, changes its shape, adapting to individual anatomical features, and this is the maximum comfort for the patient).
The price is for 1 piece.
The advantage of uterine rings compared to cup-shaped pessaries, the wall width is small. This design feature provides a smaller area of contact with the vaginal mucosa and does not prevent the outflow of secretions.
Portex uterine rings used for conservative treatment of uterine prolapse and prolapse of the walls of the vagina and uterus.
Prolapse of the uterus is a disease that occurs due to the flabbiness of the anterior abdominal wall and pelvic floor. The prolapse of the uterus is often accompanied by prolapse of the walls of the vagina with the involvement of the walls of the bladder or rectum in the process. There is a displacement of the uterus along the axis of the pelvis down, which, with the development of the disease, leads to the fact that the uterus goes beyond the genital gap - prolapse of the uterus, and the uterine rings support the cervix and prevent it from moving down.
The size is selected individually.
It should be determined by the attending gynecologist. The ring must be installed by a doctor.
Since the constant wearing of the ring can lead to the development of local inflammatory response, the formation of bedsores, erosions, fistulas and other complications, it must be periodically removed, processed and changed. In order to timely identify complications, it is necessary to visit a doctor periodically.
For the first time of using the ring at least 1 time per week, then at least 1 time in three months. The doctor should determine the time of the state of the ring by evaluating the condition of the vaginal mucosa and the test results (smear from the vagina).
The uterine ring (pessary) is supplied in non-sterile individual packaging.
Ring size matching Russian production and Portex:
- 62, 65, 68
- 71, 74 77
- 80 85
Manufacturer: Smith Medical is a leading global manufacturer of medical equipment and consumables.
The online store of medical and health products "MedMag24" invites you to get acquainted with Portex Uterine Rings and purchase them at an attractive and best price!
You have questions? We will be happy to answer them and help you with the choice. Call and order!
Article outline
Age-related changes that occur in women in adulthood, as well as the presence of various gynecological diseases can contribute to a change in the position of the uterus, its descent down and movement towards the exit from the vagina, towards the natural passage and out. This is inconvenient and fraught with the appearance of various infectious diseases. A good solution for uterine prolapse is the uterine ring.
Omission and prolapse of the uterus - what is it?
Classification
Used in gynecology different kinds pessaries. They differ, depending on the diagnosed form of prolapse, individual anatomical features of the structure. internal organs women, as well as with accompanying urination problems.
There are several types of pessaries - ring and thick ring. This type it is used for mild and moderate degrees, it has an internal elastic element that helps to effectively correct the prolapse of the uterine body.
Cup and cup perforated pessary used for mild to moderate prolapse.
urethral has a special device that supports the urethra. It is used for urinary incontinence caused by uterine prolapse.
Pessary cup-urethral used for mild to moderate omission. It is cup-shaped and helps to maintain the urethra and eliminate urinary incontinence.
Pessary Hodge- elastic device helps in cases where it is not possible to use the usual means. It is used in severe form of uterine prolapse, in identifying the anatomical features of the structure in a woman. It is made in the form of a ring, inside of which there is an elastic reinforcement, which allows changing and giving the necessary shape to the structure.
Perforated cervical pessary made in the form of a deep bowl. It has a large main and small holes in a circle. The device helps to correct the prolapse of the uterine body at a moderate degree, and is also actively used as prophylactic to prevent childbirth early dates in women with a short cervix.
Pessary cubic and cubic perforated made in the form of a cube, but without sharp corners. Has drainage holes vaginal discharge. For convenient removal of the device from the vaginal cavity, a strong thread is provided. These models are used for severe degrees of prolapse and are intended for use in a short time(from 6 to 12 hours).
mushroom pessary has a mushroom-like configuration. Thickening at the base of the leg. Designed for the deepest possible insertion into the vagina. This type of device is used for a short time when it is not possible to apply traditional forms. It is installed on daytime and leaves for the night.
All designs have a size that is very important and is selected individually. The parameters obtained as a result of clinical calculations of the capacity of the vagina are taken into account. It is carried out using special fitting rings. Self-determination of the size is fraught with consequences that promise the inefficiency and futility of using this device.
Indications for use
You need to start using the ring for prolapse in the initial phase of the disease. Before the procedure, an analysis is carried out. Take a smear for the presence various infections. There are cases where the physician without fail assigns the use of a fixture. It:
- categorical refusal of the patient from the operation;
- the need to conduct a preliminary before surgery;
- significant prolapse or prolapse of the uterus;
- the appearance of urinary incontinence;
- the need for analysis after operations;
- perfect way to save pregnancy.
Contraindications
Despite the excellent performance and significant help to a woman, uterine rings have some contraindications. They are not recommended for:
- pathology of the development of the genital organs;
- erosion of the cervix;
- colpitis;
- inflammation of the cervix;
- various formations in the small pelvis;
- bleeding with unknown causes;
- acute infectious diseases.
When using the product, you may experience side effect. As a result, inflammation of the urinary canal or the walls of the vagina at the points of contact may occur.
How to use
The doctor or the patient under his supervision should select the device, install and remove the gynecological ring for the first time. The main task of the pessary is to keep the uterus in correct position. In this regard, there should be no discomfort and inconvenience when wearing. Stages of the procedure:
- since the rings are not sterile, it is necessary to thoroughly wash the product with soap and water before use. This is done before each application and after it;
- to avoid injury and avoid internal damage tool needs to be lubricated special formulations, facilitating sliding;
- before the introduction of the means, the organ that has changed its position is returned to its natural position. The patient is in a gynecological chair, in cases where the procedure is performed in the clinic and lying on his back at home;
- The compressed ring is inserted into the vagina. It expands inside. It is important that the device does not crash, but tightly touches the cervix. Only after completing all the steps, you can climb.
When the fair sex is preparing to become a mother, she does not even imagine what difficulties she may face. Of course, most pregnancies proceed smoothly and do not have complications. However, in some cases, expectant mothers need urgent health care. Only in this case there is a chance to endure the baby and give birth to it on time. This article will tell you about what a pessary is used for during pregnancy. You will learn in what cases it is necessary to use this accessory and how to wear it.
Pessary during pregnancy: indications
This device is an excellent alternative to suturing the cervix. It is necessary for those women who have a pathology called "isthmic-cervical insufficiency." Many expectant mothers only find out at the next appointment with a gynecologist that there are problems in their body.
A pessary during pregnancy is necessary for those women who have begun premature softening or shortening of the cervical canal. In this case, the staging can be emergency or planned. Also, this device is recommended for use in multiple and polyhydramnios pregnancy, but not in every case. A uterine pessary may be needed for mothers with many children who are going to give birth for the fifth or more times.
Are there any contraindications to the setting of the unloading ring?
If the pessary during pregnancy has a planned setting method, then a temporary contraindication may be inflammatory process. In this case, the woman needs to carry out the prescribed treatment as soon as possible and install a relief ring.
When a uterine pessary needs to be placed urgently (on an emergency basis), there are no contraindications. The only factor that can affect and interfere with the process is excessive shortening and opening cervical canal.
What does the device look like and how much does it cost?
The pessary ring is made of silicone or plastic. At the same time, all edges of the device are smoothed and do not have gaps. This is necessary in order not to damage the mucous membrane of the vagina and cervix.
The device has the shape of a circle, to which several more rings are attached. The largest base is worn on the cervix. The remaining elements are necessary for unloading the bladder and rectum.
A pessary during pregnancy can be issued completely free of charge. However, this requires emergency indications. Most often, doctors, seeing the softening of the cervix, recommend not to pull and buy a medical device called a "pessary" on your own. The price of one ring can vary from 500 rubles to several thousand. It all depends on the chosen manufacturer, material and size of the device.
Installation of the unloading accessory
The installation of a pessary during pregnancy takes place within the walls of a medical institution. You will not be able to carry out such manipulation on your own. The patient is located on the gynecological chair, and the doctor is preparing at this time.
Installation of the relief ring must be carried out under sterile conditions. Most often, doctors use disposable gloves for this. An obstetric pessary is lubricated with petroleum jelly or glycerin ointment and inserted into the vagina. The doctor feels the cervix and puts a ring on it. After installing the device, the woman is under the supervision of a doctor for a few more minutes, after which she can go home.
How to wear a relief ring?
The pessary should not be removed during pregnancy. special instructions when wearing it, no. However expectant mother with such a device, you need to take a smear more often for the presence of bacterial infection. In rare cases, a pessary can become a hotbed and habitat for pathological bacteria.
It is worth noting that the unloading ring is a personal hygiene item and cannot be reused on other women. If the pessary has moved from right place, then only a gynecologist can return it back. If the device falls out completely, a new device must be used. At the same time, you need to install it again as soon as possible.
After installing the ring, many obstetricians and gynecologists recommend to behave carefully. So, the expectant mother needs to completely exclude sexual intercourse. With an increase in tone, the ring can simply fly off, which will entail irreversible consequences.
Also not allowed physical exercise. The fair sex should even refuse light gymnastics and swimming in the pool. After installing the ring, you can not take a bath. Should be preferred hygiene procedures in the shower.
If the pessary was installed urgently, then the expectant mother may be prescribed bed rest. In this case, the woman must most time to lie. You can only get up when going to the toilet or shower.
When is the relief ring removed?
The procedure for removing a pessary from a woman's vagina is carried out strictly in medical institution. Manipulation takes place no earlier than 38 weeks of pregnancy. However, if planned C-section, then the ring is removed immediately before the operation.
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