Application: The bowl or sieve bowl pessaries consist of flexible silicone, in contrast to the inflexible Falk pessaries. Therefore they are elastic and can be easily folded when being inserted and removed. Therefore the change may be painless. Preferably slighter types of pelvic relaxation and prolapse are treated by the bowl pessary. In cases with a cystocele it also supports the medial and not only the lateral defect. The contact to the pelvic floor (picture) also increases the adhesion. However, a firm pelvic floor (also if reduced) is required for this pessary.
Sizes: Various sizes of the bowl pessary can be indicated, ranging from a diameter of a minimum of 55mm to a maximum of 90mm. The pessary with the smallest diameter that just holds should be inserted. The pessary can also be used preoperatively to test the effect of a suspension operation (also to exclude possibly harmful effects) and in the same time increase tissue circulation and epithelium formation by the additional estrogen effect.
Use: In general the physician adapts the pessary on the first examination. Under stress like coughing, pressing and movements it should be tested whether the pessary holds. A coating with an estrogen cream facilitates the insertion. After the test, the position of the pessary should be checked again. The pessary should be changed by the patient herself, i.e. she has to remove it in the evening and to insert it in the morning. Thereby the pessary should be covered with an estrogen cream. Exclusively creams containing estriol
(short adhesion on the receptor) should be used. Since one needs a relatively large amount of cream (large surface) to reach a gliding ability, we recommend to use a low dispensed cream with 0.1 mg estriol / 1 g cream, in rare cases with 0.5 mg estriol / 1 g cream. The estriol also ensures a better blood circulation and epithelium formation. The change of the pessary may be done in a standing position 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 week intervals. Under these conditions, one should insert an estriol cream or ovulum once a week.
Side Effects/Complications: The therapy with the bowl pessary has the aim -in combination with additional measures - to reduce the patient's problems due to the 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, or obstruction from a neglected pessary. If the prolapse is insufficiently cured or if various sizes do not stay in their position, one has 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.