Ring and Donut Cushions: When They Help and When They Do Not

What a ring cushion is

A ring cushion, also called a donut cushion, is a round or oval cushion with a central opening. Common types are:

• Inflatable rubber or vinyl rings, blown up by mouth or a pump.
• Foam rings, made from firm or memory foam.
• Gel rings, with a gel layer in a foam ring.

They come in different sizes, typically about 35 to 45 cm across with a hole of 8 to 12 cm.

The theory

The idea is that a sore area, such as the tailbone, an inflamed pile or the surgical wound near the anus, can sit over the hole and avoid pressure while the surrounding tissue carries the weight. For short-term, mild discomfort that might be so.

The problem

The problem is what happens at the edge of the ring.

• Pressure concentrates around the hole. The weight that would have gone through the middle is carried by the ring, so the tissue around the sore area is squeezed hardest, and the blood vessels around the edge can be compressed.
• Blood flow to the sore area can fall. The ring can restrict circulation to the very tissue it is meant to protect, because tissue in the hole is held in a position where it can bulge, swell and be stretched.
• Swelling can increase. Tissue pushed through the hole can swell, particularly with an inflamed pile or a healing sore.
• Shear increases at the edge. Movement can drag the skin around the edge.
• The ring can create new sore areas on the thighs and buttocks.

For these reasons, major pressure-ulcer guidelines advise against ring and donut devices for preventing or treating pressure sores. Healthcare professionals generally avoid them for that purpose.

When a ring cushion may be acceptable

A ring or cut-out cushion may help for short periods in some situations, usually where the problem is pain, not pressure damage, and on a doctor's or therapist's advice:

• Tailbone (coccyx) pain after a fall or childbirth, where a person needs to avoid direct pressure on the tip of the spine. A wedge or cut-out cushion designed for the coccyx is usually better than a simple ring; see cushions for piles and tailbone pain.
• Haemorrhoids (piles) or anal discomfort, for short sitting periods. Some people find it comforting, though evidence is limited.
• After certain surgeries, when advised by the surgeon.
• Short sitting, such as a car journey, where comfort is the goal and the person has intact skin and good sensation.

In these cases, use the ring for short periods, move often and stop if pain or skin changes appear.

When to avoid it

Avoid ring cushions:

• If there is a pressure sore or the skin is red and does not fade. See a nurse or doctor instead; see pressure ulcers: stages, wound care and prevention.
• For people at risk of pressure sores, such as those with limited movement, thin skin, reduced sensation, diabetes or poor circulation.
• For people who sit for long periods, in wheelchairs or armchairs.
• For anyone with swelling of the legs or buttocks.
• If circulation is poor, because the ring can reduce blood flow.
• If the ring is inflated too hard, as a hard ring is worse than none.

What to use instead

For pressure relief and skin protection. A properly designed pressure-relieving cushion, such as a gel, gel-foam, high-quality foam or air cushion, chosen by a therapist; see gel cushions for pressure relief and seat cushions for older adults.

For tailbone pain. A wedge or cut-out cushion with a U-shaped opening at the back, rather than a full circle, which supports the thighs and relieves the tip of the tailbone.

For piles. Soft, supportive cushions that do not squeeze, plus medical treatment: fibre, fluids, avoiding straining and a doctor's advice; see constipation in older adults and psyllium husk.

For general comfort. A medium-firm foam cushion, or a lumbar cushion for the back; see lumbar cushions.

For movement. Regular weight shifts, standing and walking breaks and good posture, which matter more than any cushion.

For skin. Keep it clean and dry, check daily, and use barrier creams where moisture is a problem; see barrier creams and skin care.

If you already use a ring cushion

• Check the skin under and around the ring, in good light, for redness, marks, blisters and swelling.
• Limit use to short periods.
• Do not over-inflate. An inflatable ring should be soft enough to dip when you sit.
• Ask a nurse or therapist whether it is suitable for your parent, especially if they sit for long.
• Replace it with a more suitable cushion if there is any skin damage or high risk.
• Stop at once if there is more pain, redness or swelling.

Piles, tailbone pain and other conditions

These conditions need proper attention, not just a cushion. Persistent rectal bleeding, severe pain, a lump or a change in bowel habit needs a doctor, especially in an older adult, because other conditions can look similar. Tailbone pain that lasts more than a few weeks, or follows a fall, should be checked. Sitting a lot, constipation and straining contribute to many bottom problems. Good fibre, fluids, activity and toilet habits help; see constipation in older adults.

Hygiene

Rings can trap sweat and moisture. Use a washable cover, wipe the ring and dry it, and do not share it. Inflatable rubber can degrade in heat and sun. Replace worn or cracked rings.

Buying, if you must

If a professional advises a ring or cut-out cushion for a short-term problem:

• choose a firm foam ring, rather than an overly soft or very hard rubber one;
• choose a size that fits the seat and the person;
• choose a breathable, washable cover;
• check that the hole is neither too large nor too small; and
• try it for a short time.

Be careful with claims that a cushion "relieves all pressure" or "heals bedsores". No cushion does.

Talking to a parent who loves their ring cushion

Many older people have used a ring cushion for years, and may resist being told it is the wrong choice. Start by asking what it does for them: is it the soft feeling, the relief from tailbone pain or the habit? Then explain that the aim is the same comfort with less risk, and offer a trial of a better cushion alongside, not instead, for a week. Check the skin together, which is the most convincing evidence. If the skin is fine and the ring helps for short sittings, a doctor or nurse may accept it as a comfort aid while the proper cushion is used for long sitting. If there is any redness that does not fade, take the ring away at once and call a nurse. Respect their sense of control: let them choose the colour, cover and place of the new cushion, and keep the old one for short trips only if the nurse agrees.

When to ask a professional

See a nurse or doctor promptly for any area of skin that is red, painful, broken or blistered; for tailbone pain that persists; for rectal bleeding; or for a lump or swelling. An occupational therapist or nurse can recommend a proper cushion for long sitting or pressure risk. Our care advisors can arrange a nurse visit and recommend equipment.