Trip Answers

Question answered:26/09/07 Warning! this question is over two years old.

Over the past couple of years, we have been asked this question a number of times. We have undertaken a new literature search in the TRIP and Medline databases but have found no additional guidance or studies on this topic since we answered this question in January 2007 [1]. Thus, we will reproduce this answer, below:

 

We searched the National Library for Health, TRIP and the Medline database but found no guidelines or studies providing recommendations and supporting evidence determining the frequency with which ring pessaries should be changed in patients with stress incontinence or prolapse.

 

However, GPNotebook, an online encyclopaedia, has an entry on ring pessaries which states:

 

“This may be used in the treatment of uterine prolapse or stress incontinence. Ring pessaries must be changed regularly - usually every 4-6 months - and before replacement, must be washed and the vagina inspected to exclude trauma.
Ring pessaries are only satisfactory for the lesser degrees of prolapse or for mild stress incontinence.” [2]

 

In addition, Viera and Larkins-Pettigrew writing in the “American Academy of Family Physicians” journal offers the following information:

 

“After the initial fitting of the pessary, the patient should be followed-up within a few days so that the physician can recheck the fit. The pessary should be removed so that the vagina can be examined for irritation, pressure sores or allergic reaction. Having to change the size of the pessary at least once after the initial fitting is not uncommon. The patient should then be instructed to follow-up within one to two weeks for another examination, after which time the examinations can be spaced to every two to three months. In the motivated patient who is able to demonstrate effective removal, insertion and care of the pessary, these examinations may be spaced further at the discretion of the physician.
At each follow-up examination, the pessary should be removed and cleaned with soap and water while the vagina is inspected for erosions, pressure necrosis or allergic reaction. If inspection of the pessary reveals cracking or other defects, it should be replaced. The patient who is using a pessary should be considered to be under the care of the person who placed it for the duration of its use. Pessaries should never be placed in elderly, debilitated patients without excellent follow-up.” [3]

References
1. NLH Q & A Service. How often are vaginal (prolapse) rings changed?  January 2007. (http://www.tripanswers.org/Answer.aspx?QuestionId=4040)
2. GPNotebook. Ring pessary. (http://www.gpnotebook.co.uk/simplepage.cfm?ID=1751842828).
3. Viera A and Larkins-Pettigrew M. Practical use of the pessary. American Academy of Family Physicians. May 2000;61(9). http://www.aafp.org/afp/20000501/2719.html).

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