Patent Publication Number: US-11660220-B2

Title: Intergluteal hemorrhoid pad

Description:
CLAIM OF PRIORITY 
     The present application includes subject matter disclosed in and claims priority to co-pending prior-filed U.S. Pat. No. 10,398,582 entitled INTERGLUTEAL HEMORRHOID PAD, filed Jun. 3, 2015, describing inventions made by the present inventor, hereby incorporated by reference. 
     FIELD OF THE INVENTION 
     The present invention relates to hemorrhoid relief devices. More particularly, the present invention relates to an exterior intergluteal pad positioned to adjust pressure(s) associated with internal and external hemorrhoids. 
     BACKGROUND OF THE INVENTION 
     Hemorrhoids, and varicose veins, create perianal discomfort in a large population of people. Discomfort is caused by numerous issues associated with the varicosities, such as, swelling, prolapse of sensitive anal tissue, drying of prolapsed tissue, localized trauma, chafing of external hemorrhoids, sensitive prolapsed internal hemorrhoids, thrombosis, or a persistent bleeding/healing cycle. Pressures and rubbing in these areas can cause a feeling of discomfort, as well as cause trauma which can exacerbate conditions, delays recovery and activate nerve cells that indicate pain and injury. 
     Traditional approaches to hemorrhoid relief have included medicated pads, suppositories, and/or topical ointments. None of these products addresses the anatomical reasons for hemorrhoid discomfort. Hemorrhoidal sitting alters the anatomy of the anal area, and can worsen hemorrhoid symptoms by exacerbating prolapse of internal and external hemorrhoids. When a patient or user exhibiting the symptoms of hemorrhoids takes a sitting position, venous pressures increase, which can cause or exacerbate hemorrhoids. 
     It is therefore an object of the present invention to provide a pad for the relief of discomfort associated with hemorrhoids. 
     It is a further object of the present invention to provide external application of a spacer for the relief of pressure associated with swollen varicose anal veins. 
     It is yet another object of the present invention to provide perianal treatment post-operative or post-trauma. 
     It is still yet another object of the present invention to provide a pad for application of therapeutic medications perianally. 
     It is another object of the present invention to selectively apply pressure to perianal issue. 
     SUMMARY OF THE INVENTION 
     The present invention provides relief of hemorrhoid discomfort by making gentle beneficial alterations to the perianal, anal, and hemorrhoidal anatomy, as well as the anatomy of the surrounding tissue. Beneficial alterations to the anatomy include gentle separation of the gluteal cheeks, external support of hemmorhoidal tissue with a cradling effect on inflamed or prolapsed or related perianal tissues, while providing absorption. Alternatively, the present invention can include various contours and/or nubs to apply pressure in specific locations in, on-or-around the affected area to provide relief of pain or discomfort and/or manual reduction in prolapse or swelling. 
     The present invention is intended as a single-use disposable product, and may be sterile. It is preferably composed of malleable, absorbent material, e.g. cotton, synthetic fibers, polymer, polyester, rayon, cellulose, viscose, wood, rubber, foam, fibers, blend of fibers, etc. The material may be flushable (as is known in the art), or non-flushable. The present invention is not meant for internalization into the anorectal canal. The present design can allow for application of accepted hemorrhoidal medications for additive relief via impregnated foam body or body portions. 
     When an embodiment of the present invention is in use, it is preferably gently inserted between the separated gluteal cheeks providing improved separation and pressure adjustment. The pad surface interfaces with the external anal canal and is contoured to provide support with a pressure level chosen by the user based on positioning of the intergluteal pad in relation to anatomy and any hemorrhoid(s). A trapezoidal cross section may facilitate proper placement. The interface surface may include cavities or extensions to mate with hemorrhoid anatomies. The interface surface can act as a platform to hold accepted hemorrhoid topical medications. The device is intended to be worn between two and twelve hours. 
     In one alternative embodiment of the present invention, an intergluteal spacing device allows selective pressure application and pressure relief in and surrounding the anus. The device preferably includes an elongated body to fit within the intergluteal space with a dorsal (or posterior) end (i.e. positioned upwards for a standing individual) and a ventral (or anterior) end (i.e. facing downwards). It is preferred that at least a part of the central portion of the device would be positioned in direct contact with, or opposite, the anus. The central portion may include at least one cavity to provide the pressure relief over an affected area, such as a prolapsed hemorrhoid, or the cavity can extend over the totality of the perianal. The central portion may have one, two, or more cavities to provide place specific pressure relief and/or adjustment in multiple areas. In one preferred embodiment, the device may be in the form of a trapezoid, with the narrow top fitting up against the perianal skin, while the wide bottom faces outward away from the perianal and serves to support gluteal cheek separation. Alternatively a rectangular shape, or a rounded or wedged shape, can be used. The end(s) may terminate in a beveled shape. The device may alternatively include a convex top to provide ease and comfort to the wearer, the top being generally convex or flat with a portion, or portions, concave to provide a cavity or cavities. The concave section may include a wrap-around concavity (including top and sides) covering at least one hundred-eighty degrees of the midline to provide additional pressure relief opposite the anus. 
     An adhesive may be used to affix the device onto the skin, so as to prevent movement, trauma, etc. Certain portion, or portions, of the device may include adhesive. In one embodiment, the ends are covered with adhesive. In some embodiments, the top surface includes portions with adhesive applied, in other embodiments, adhesive may be set all around device, or on sides interfacing with gluteal cheeks. In another embodiment, the anterior end is split in two, to provide adhesive attachment near the perineum, or along the thighs, and the posterior end to be adhered between the gluteal cheeks, or conversely, or lacking adhesive. 
     In an alternative embodiment, the device may include one, or more, nubs arranged to selectively apply and/or relieve pressure on a section in and/or around said anus. The portion facing the skin may be textured to include an array, pattern, or individual nub or nubs. The nubs may be impregnated with a therapeutic, or medicated, solution, such as a cream, ointment, or liquid. 
     The invention also contemplates a method for achieving comfort and relief from pain or discomfort associated with the signs and symptoms of hemorrhoids. The method includes applying an intergluteal spacer between the gluteal cheeks, the top surface may include a cavity for relative pressure relief upon inflamed perianal tissue. The method may include the step of adhering an adhesive to the skin to secure the spacer in a specific effective location. The method may also include the step of positioning one or more nubs at a specific location to selectively apply pressure upon, near, or opposite the inflamed or prolapsed tissue, and/or to restore normal anatomy. Applying pressure may include repositioning of pressures, tissues, or alleviating pressure on nerves. Therapeutic solutions may be delivered and/or secured to the area and/or skin via the spacer. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention can be further illustrated through a description of certain embodiments. 
         FIG.  1 A  demonstrates a perspective view of a side of an embodiment of the present invention. 
         FIG.  1 B  demonstrates a side view of an embodiment of the present invention. 
         FIG.  1 C  demonstrates an end view of an embodiment of the present invention. 
         FIG.  2 A  demonstrates a side view of an embodiment of the present invention. 
         FIG.  2 B  demonstrates a top view of an embodiment of the present invention. 
         FIG.  2 C  demonstrates an end view of an embodiment of the present invention. 
         FIG.  3    demonstrates a top view of an alternative embodiment of the present invention. 
         FIG.  4    demonstrates a top view of an alternative embodiment of the present invention. 
         FIG.  5    demonstrates a top view of an alternative embodiment of the present invention. 
         FIG.  6 A  demonstrates a top view of an embodiment of the present invention. 
         FIG.  6 B  demonstrates a side view of an embodiment of the present invention. 
         FIG.  7 A  demonstrates a side perspective view of an embodiment of the present invention. 
         FIG.  7 B  demonstrates a top perspective view of an embodiment of the present invention. 
         FIG.  7 C  demonstrates an end view of an embodiment of the present invention. 
         FIG.  8 A  demonstrates a top view of an embodiment of the present invention. 
         FIG.  8 B  demonstrates a side perspective view of an embodiment of the present invention. 
         FIG.  9 A  demonstrates a top view of an embodiment of the present invention. 
         FIG.  9 B  demonstrates an end view of an embodiment of the present invention. 
         FIG.  9 C  demonstrates a side view perspective of an embodiment of the present invention. 
         FIG.  10 A  demonstrates a side view of an embodiment of the present invention. 
         FIG.  10 B  demonstrates a side perspective view of an embodiment of the present invention. 
         FIG.  11    demonstrates a lateral side perspective view of an embodiment of the present invention. 
         FIG.  12 A  demonstrates a top view of an embodiment of the present invention. 
         FIG.  12 B  demonstrates a side view of an embodiment of the present invention. 
         FIG.  12 C  demonstrates a bottom end view of an embodiment of the present invention. 
         FIG.  12 D  demonstrates a top end view of an embodiment of the present invention. 
         FIG.  13    demonstrates a lateral side view of an embodiment of the present invention. 
         FIG.  14    demonstrates an end view of an embodiment of the present invention. 
         FIG.  15    demonstrates an end view of an embodiment of the present invention. 
         FIG.  16    demonstrates a perspective view of an alternative embodiment of the present invention. 
         FIG.  17    demonstrates a perspective view of an alternative embodiment of the present invention. 
         FIG.  18 A  demonstrates a top view of a cover of the present invention. 
         FIG.  18 B  demonstrates a side view of a cover of an embodiment of the present invention. 
         FIG.  19    demonstrates a top view of a cover of the present invention. 
         FIG.  20    demonstrates a perspective view of an alternative embodiment of the present invention. 
         FIG.  21    demonstrates a perspective view of an alternative embodiment of the present invention. 
         FIG.  22    demonstrates a top view of an embodiment of the present invention. 
         FIG.  23    demonstrates a cross-sectional view along the line  23 - 23  of  FIG.  22   . 
         FIG.  24    demonstrates a cross-sectional view along the line  24 - 24  of  FIG.  22   . 
         FIG.  25    demonstrates a top view of an embodiment of the present invention. 
         FIG.  26    demonstrates a cross-sectional view along the line  26 - 26  of  FIG.  25   . 
         FIG.  27    demonstrates a cross-sectional view along the line  27 - 27  of  FIG.  25   . 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     The present invention includes various shapes and features that may be applied to a spacer pad that can be placed between the gluteal cheeks for the relief of pressures and trauma associated with hemorrhoid symptoms. The product may provide gentle separation of the gluteal cheeks, and external support of hemmorhoidal tissue with a cradling effect on inflamed or prolapsed or related perianal tissues, while providing absorption and/or therapeutic solution(s). The product may be used as a post-surgical anoperineal dressing. The surface of the spacer may include at least a feature whereby pressure may be adjusted, or relieved, such as a cavity or a concave portion. When applied to the skin or over a hemorrhoid, a cavity allows hemorrhoidal, or any select perianal, tissue a low-pressure space to comfortably sit. Alternatively, a convex or flat surface on the device can provide counter-pressure against a prolapsed internal hemorrhoid or external hemorrhoid. In one preferred embodiment of the present invention, the pad is made from cotton blend, whereby the pad structure can be maintained in a predetermined form to maintain its fit while adapted to mate with the skin or a portion of the pad can conform to the body, while the remainder of pad retains its shape. The type of material preferred for the invention is gentle enough to allow the pad to conform to a prolapsed or inflamed tissue, thereby providing support in its current form. Products embodying the invention may include cellulose, or rayon, or other materials as described herein or as known in the art, with varied structure, density, and hardness within the device. The gentle invention structure can push up against inflamed, swollen, or prolapsed tissue, and support the shape of the tissue, reducing pressure on the anatomy. Inflamed exterior hemorrhoids may be similarly supported. The pad is meant for short term relief and/or post-surgery relief. The pad may be placed temporarily, and replaced with a new pad when absorbent capacity is reached. 
     Referring now to drawings of the preferred embodiments,  FIGS.  1 A-C  demonstrates an embodiment of the present invention. Intergluteal pad  1  has top  4  adapted to contact the human perianal and surrounding skin within the intergluteal space and along the skin surface. Bottom  5  is adapted for outwardly facing, i.e. away from the anus. Left side  8  and right side  9  provide additional optional surface area to contact with the interior of the left and right gluteal cheeks. Intergluteal pad  1  contains an anterior end  2  adapted for facing towards the perineum, and posterior end  3  adapted for facing towards the coccyx. The top may contain features such as the pressure elements  6  and concave spaces  7  which can provide for cavities  10 . Top  4  may include an interactive surface  11 , which may include an adhesive to affix the pad in place, creams for therapeutic use, nubs, etc. 
     Therapeutic medications (solutions) may be impregnated into pressure elements, particularly when such elements are to be positioned to provide pressure on, or for the manual reduction of, prolapsed, inflamed, or swollen tissue. Cavities may alternatively be coated with topical medication to allow pressure-relieved prolapsed, inflamed, or swollen tissues to gently receive medication initially, and when prolapsing exaggerates the size of prolapsed tissue or swelling. 
     Furthermore, the intergluteal pad is preferably comprised of a cotton blend. Alternatively, the pad is made from a firm foam, preferably petroleum based or (synthetic) rubber. In one embodiment, the pad may be impregnated with a liquid for the application of therapeutic treatments, such as pain relief, steroids, non-steroidal anti-inflammatory, clotting agent, hemostatic lubricant, anti-biotic ointment, topical skin protectants, such as zinc oxide, titanium dioxide, salicylic acid, urea, and vitamins, etc., and barriers, etc. The invention may be used to treat damaged tissue in the perianal area, or used for post-operative treatment. After surgery, the invention may be used to secure, support, or treat damaged/healing tissues, or may be used as a means for post-operative manipulation of part or all of the perianal tissues. The invention can be used to treat or support tissue with stitches, such as post episiotomy, or used post child-birth. The invention may be used to treat damage, trauma, swelling or irritation caused by Crohn&#39;s disease, perianal fistula, or any fissure or abscess. The invention may be used to treat any perianal diseased state or perianal tissues. 
     When adhesives are used in this embodiments or others, common mild adhesives known in the art are contemplated as best mode for the temporary affixing of a product to human skin, preferably an adhesive more mild than a typical bandage. 
     Cavity  10  may include sidewall  12 , which may be flat, and may be formed at a right angle from surface  11 . Cavity defines a specific volume of space for controlled pressure adjustment, being further defined by cavity base  13 . In this embodiment, sides of cavity  10  remain open to allow the user&#39;s gluteal cheeks to enclose the cavity space so to provide relaxed pressure relief to an anal area opposite the cavity base  13 . 
     Intergluteal pad  1  may also include sides  8  and  9  with alternating angles to better provide for fit and/or comfort when applied. While hemorrhoids can come in any position three hundred-sixty degrees surrounding the perianal, most common hemorrhoids are left lateral, right anterior and right posterior. In the embodiment in  FIGS.  1 A-C , left side  8  meets top  4  surface  11  at a right angle, while right side  9  meets top  4  at an obtuse angle  15 . Acute angle  16  joins bottom  5  with side  9 , and preferably complements obtuse angle  15  to form a complete one hundred-eighty degrees (combined). Preferably the angle is approximately one hundred thirty-five degrees, but may vary from ninety to one hundred-fifty degrees. In this instance, top  4  is narrow while bottom  5  is wider, to provide for ease of fit and better form fit between the gluteal cheeks. Partial cross-section is demonstrated as seen in side view  1 C, demonstrating semi-trapezoidal shape. Substantially trapezoidal shape contemplates either sharp exterior edges  110  (as shown) or rounded edges that retain the angle of interface as between the sides/tops/bottom. Depending on specific patient condition, intergluteal pad  1  can be flipped one hundred-eighty degrees side-side to make the anterior end posterior and posterior end anterior, while maintaining top in body-facing position. 
     Referring now to  FIGS.  2 A-C , an alternative embodiment of the intergluteal pad  1  includes a trapezoidal shape. As seen in  FIG.  2 C , the pad includes a trapezoidal shape, whereby top  4  leads to sides  8  and  9  at a substantially identical obtuse angle  15 , and sides meet base  5  at a substantially identical acute angle  16 . (For the purposes of this specification substantially and substantially identical means+/−5 degrees). Preferably obtuse and acute angles  15  and  16  add up to one hundred-eighty degrees, and preferably obtuse angle is between one hundred and one hundred-forty degrees, most preferably one hundred-ten degrees, and acute angles make up the difference to one hundred-eighty degrees. In this manner, the symmetric shape of the pad allows for adjustment, whereby posterior end  3  may be positioned wither posterior or anterior, allowing the pad to be rotated freely. When top  4  includes varied features (described below  FIGS.  3 - 5   , etc.), the product can be adjusted as necessary. To provide additional adaptation to the anatomies of the intergluteal area, posterior end  3  and anterior end  2 , may also include a gradual obtuse angle off of top  4 . This allows for a more gradual pressure at the ends of the pad when applied and used, especially when the user is sitting down or the gluteal cheeks are otherwise under pressure or alternatively, separated. Adhesives may also be included on sides, such as sides  8  and  9  to secure pad  1  in place against skin of gluteal cheeks. 
     As shown in  FIGS.  3 - 5   , top  4  may include varied features for the preferential and optional positioning of varied pressure adjusting features for application to the hemorrhoidal areas. As seen in  FIG.  3   , top  4  may include pressure elements  6  in a non-symmetrical fashion. Certain cavities  70  may have varied sizes and/or shapes. For instance large cavity  71  is notably larger (by means of lengthening between ends  2  and  3 ) to provide additional pressure relief to the perianal anterior. Feature  6 A may be positioned over a portion of, or the totality of the anus. Feature  61 , or any pressure feature  60 ,  61 ,  62 ,  63  et al., may include a varied material that provides extra absorption to collect discharged blood, liquid, and/or to provide selective application of pre-impregnated therapeutic solution. Cavity  72  may be positioned above posterior side of the anus, or over specific hemorrhoidal bulges. The device, as always, can be flipped, based on the condition and/or preference of the user. 
     As seen in  FIG.  4   , top  4  may include central cavity  73  rounded to better fit the features of the anatomy. In this instance, cavity  73  can be sized for adaptation over the center of the anus, to accommodate/cradle/support bulging of internal prolapsed hemorrhoids. When central cavity  73  is smaller than external hemorrhoids, pressure elements  62  may be positioned over the external hemorrhoids to provide pressure on external hemorrhoidal plexus and/or against the sphincter muscle, and to prevent varicosities from expanding laterally beyond the perianal, or protect any prolapse or swelling tissues from trauma. Further cavities  1700  may be provided to allow other hernias or external hemorrhoidal or prolapses space for pressure relief. Alternatively, cavities  170  provide for more flexibility of pressure elements  62  to migrate/bend as needed or forced by the geometry of the area. 
     As seen in  FIG.  5   , vertical pressure element  63  can be provided on one side of intergluteal pad  1  to specifically target non-symmetrical, (e.g. left lateral) hemorrhoids that may appear on one side or the other. Concave space  7  provides for pressure relief and to allow additional pressure contact of pressure element  63 . Given the symmetrical shape of sides  8  and  9  and ends  2  and  3 , the added benefit contained in this embodiment is the ability to flip the product so as to position the pressure element  63  on either side, as needed. When flipped, posterior end  3  is positioned anteriorly and anterior end  2  is positioned posteriorly. 
     Referring to  FIGS.  6 A-B , an alternative embodiment is shown. Intergluteal pad  101  includes body  125  for insertion over the perianal. Contact surface  124  on top  104  may contact the anus, external hemorrhoidal plexus and/or prolapsed hemorrhoids or other hernia external of the patient&#39;s body. As seen in  FIG.  6 B , body may include wedge shape  123  opposite wide base  113  to allow for more comfortable fit between the gluteal cheeks, and well as to provide directed pressure to the perianal. Body  125  meets necks  122  via slopes  127 . Slopes allow for additional space between necks  122  and the patient&#39;s skin. On anterior end, necks may be preferably bifurcated, terminating in preferably two heads  120 . Heads  120  may be affixed to either side of the genitalia and/or the inner thigh of the patient. Heads  120  preferably include adhering surface  126  to affix to the patient and keep the product in place. Adhering surface  126  preferably includes an adhesive to hold pad  101  to patient&#39;s skin. Posterior end  103  includes posterior end  121 , attached to body  125  via neck  122 . Posterior head  121  may be affixed between the gluteal cheeks to further secure pad  121 . Pad  101  may be flipped, whereby bifurcated neck pads  126  affix to gluteal cheeks, and/or device may include a single neck on either side, or dual necks on both sides. 
     Preferably, when handle  99  is used in conjunction with the embodiment shown in  FIGS.  6 A and  6 B , handle is positioned at the bottom towards posterior end  103 , as shown. Handle  99  is preferably a soft flexible string, such as cotton, synthetic fiber, plastic, etc. However, handle may be affixed to head  121 , or heads  120 , or otherwise mounted at bottom near anterior end  102 . 
     Referring to  FIGS.  7 A-C , intergluteal pad  1  may include flat and convex top  4 , absent of any lowered or raised features such as concave spaces, cavities, or nubs. Pad maintains a trapezoidal cross-sectional shape, and may include a set shape through, or may taper on one or more ends (retaining scaled trapezoidal cross section). Ends  2  and  3  may be flat (meeting at ninety degrees with top  4  and bottom  5 ) or may be beveled extending from top  4  with an obtuse angle and meeting bottom  5  at acute angle. Pad  1  may include one or more adhesive  18  to contact patient skin. It is preferable to include adhesive  18  on top  4 , towards ends  2  and  3 . Adhesives  18  can be applied along intergluteal space on alternative sides of patient anus. 
     Referring to  FIGS.  8 A-B , intergluteal pad  201  may include body  225  with cavity  210 . Cavity  210  is defined by border of pressure element  206  along top  204 . Preferably, pressure element  206  is sized to surround the anal opening and apply pressure around the external hemorrhoidal plexus, and/or support recessed cavity  210 . Body  225  extends to posterior end  203  via posterior post  230 , whereby post is adapted to fit between gluteal cheeks. Anterior end  202  includes anterior post  221  to fit ventrally. Posts  230  and  231  may preferably include surface adhesive to affix pad to patient&#39;s skin. Adhesive may also or alternatively be applied along pressure element  206 . Cavity  210  may include ridges  216  to provide a variegated surface structure. Extending sides  232  provide for a shape that extends wider than posts  230  and  231 , to surround features of patient&#39;s perianal. 
     Referring to  FIGS.  9 A-C , intergluteal pad  301  includes an alternative wishbone shape with wraparound concavity  343  along the center portion of body  325 .  FIG.  9 A  includes broken lines to denote contour. Sides  308  and  309  include sloping sides  334  and flat sides  335  providing a shape viewed along the side as shown in  FIG.  9 B . 
       FIGS.  10 A and  10 B , demonstrate an intergluteal pad  1  with alternative concave section  7  that is rounded to provide gradual pressure relief and remove harsh edges. 
     As shown in  FIGS.  11  and  12 A -D, intergluteal pad  1  may include a shape with narrow ends whereby anterior end  2  includes bow  40  and posterior end  3  includes stern  41 . Bow  40  narrows to bow edge  42  to make insertion and positioning easier in light of the geometry of the perianal and perineum region. Flat sides  35  may curve to provide appropriate shape to pad  1 . As shown in  FIG.  12 B , concave space is defined by base  13  and walls  12 . Walls  12  may be angled off of ninety degrees to provide for a smoother feel. 
     Referring to  FIGS.  13 - 17   , intergluteal pad  1  may come in varied forms and shapes, such as rectangular ( FIGS.  14  and  16   ) and trapezoidal ( FIGS.  15  and  17   ). 
     As shown in  FIG.  13   , intergluteal pad  1  (such as that shown in previous figures) may include various zones for the inclusion of impregnated therapeutic solutions along a top or portion intended to interface with the perianal area. Top section  91  may include all or most of the top surface for impregnation of a therapeutic solution around the coddled tissue, or may include anti-inflammatory drugs to reduce swelling. Top section  91  may also include impregnated mild adhesives to secure the product in place. Top section  91  may include corners  92 , or other concentrated sections, such as at an inflection point, that may also provide zones for impregnated therapeutic solutions or adhesives. For instance impregnation may be applied in cavities, such as cavity surface zone  93 . Cavity surface zone  93  may include lining which is impregnated with therapeutic solution, particularly when the cavity is placed over swollen or prolapsed tissue to provide steroidal or non-steroidal relief. As such, any portion  91 ,  92  or  93  can also include a variety of similar or dissimilar medications, such as therapeutic solutions, such as pain relief or any solution as described above. 
     As shown in  FIG.  14   , backplate  95  may be included in intergluteal pad  1  to provide for support of the pad. Backplate  95  may be made from a stiffer material than the remainder of the pad in order to retain the shape when placed intergluteally. Material for backplate may include a metal, hard plastic, rubberized material, cellulose, or otherwise stiff material known in the art. As shown in  FIG.  15   , backplate  95  may be paired with a standard material zone  96 , whereby the standard material zone provide further support to the pad, but not at the expense of the top region for contact with the patients perianal regions or impregnation of solutions. Preferably, back plate is less susceptible to migration of liquids and creams, and more preferably provides a barrier to solutions passing through top section and through lower section covered by backplate. Zone  96  can also be made from a material that prevents impregnated solutions from migrating too far from the top of the pad, such as a hydrophobic material. Pad  1  may also include an internal matrix/skeleton (not shown) to provide support for the shape of pad  1  when used as a spacer. The matrix may be made of a different material than the pad, one more firm/stiff than cotton, such as plastic, metal, etc. 
     As shown in  FIGS.  16  and  17   , pad  1  may include access handle  99 , such as a string affixed to ends  2  or  3 . Handle  99  allows for easier removal of the pad when emplaced on a user and in need of replacement or removal. Handle  99  may be placed on one or both ends. When the product is symmetric, and the user may determine the most convenient location for the single handle and place it anteriorly or posteriorly. Handle  99  is preferably a cotton string mounted or secured within pad  99  to allow longitudinal and lateral pulling on the handle to exert a force on pad  1  to remove from user. Mounting of handle may be secure enough to overcome adhesive application, in order to remove the pad. 
       FIGS.  18 A-B  and  19  demonstrate alternative top surface features and an alternative embodiment of the present invention as may be used with a variety of spacer and pad shapes as features on top  4  (as shown above). Roof  400  may include top  451  defined within edges  452 . Top  451  provides nodes  450  which act as bosses, or nubs, to apply pressure in specific areas. Nodes  450  may be arranged in an array  456  to provide regular surface pressure features. Alternatively, as shown in  FIG.  19   , nubs  450  may include large nubs  454  and small nubs  455  to provide alternate pressures. The center  401  preferably includes larger nubs  454  while smaller nubs  455  provide a less pronounced surface towards sides  402 . As seen in  FIG.  18 B , roof  400  may be a thin plane with adhesive plane  457  directly below and opposite nubs  450  on top  451 . Roof  400  is to be applied to intergluteal pad (not shown) via adhesive plane  457  to provide a specific pressure surface to the intergluteal pad device. In the alternative, roof  400  may be used directly as a pad to provide selective surface features and pressures and pressure relief. When roof  400  is used in isolation of greater pad as a sort of thinner product, roof  400  is bent in half (with nubs exposed outwardly), and fitted between the gluteal cheeks and perianal. Nubs  450 , particularly nubs around outside perimeter, may include surface adhesive to secure roof  400  in place. Nubs, preferably at least one of the larger nubs  454  may encapsulate, or be impregnated with a therapeutic solution for selective application. Nubs may alternatively include a stiff material to help apply pressure or effect manual reduction in prolapse or swollen tissue. Stiff material herein may include a more dense material, or an alternative material. 
       FIGS.  20  and  21    demonstrate various embodiments of pad  1  that are further detailed in  FIGS.  22 - 24    and  FIGS.  25 - 27    respectively. As shown in  FIG.  22   , pad  501  includes ends  502  and  503 , and sides  508  and  509 . Side edges  520  form edge of top  504 . Gently sloping concave sections  507  feature on top  504 . Pressure elements  506  rise at the ends and pressure feature  560  is centered and includes a full three hundred-sixty degree mound. Concave sections  507  include cavities  510  falling on sloping sides  534  and base  513 . As seen along cross section  23 - 23  of  FIG.  22   ,  FIG.  23    represents a cross-section of  FIG.  22   . Pressure feature  560  is demonstrated as a mound in profile. Lateral sides  535  and  536  slope from peak  561  to edge  520  at sides  508  and  509 . As seen along cross section  24 - 24  of  FIG.  22   ,  FIG.  24    represents a cross-section of  FIG.  22   . Center mound pressure feature  560  slopes down sides  534  to cavity base  513  between ends  502  and  503 . Between center pressure feature  560  and end pressure elements  506 , cavities  510  form with base  513  at the bottom. 
     As shown in  FIG.  25   , pad  501  includes ends  502  and  503 , and sides  508  and  509 . Gently sloping concave section  507  features on top  504 . Pressure elements  560  rise at either side of central cavity  510 . Top  504  is rimmed by edges  520 . Ends have partial cavities  517 . As seen along cross section  26 - 26  of  FIG.  25   ,  FIG.  26    represents a cross-section of  FIG.  25   . Center cavity  510  includes base  513  and sloping lateral sides  535  and  536  to edges  520  at sides  508  and  509 . As seen along cross section  27 - 27  of  FIG.  25   .  FIG.  27    represents a cross-section of  FIG.  25   . Center cavity  510  includes base  513  and sides  512 . Separate mounds, or pressure features  560 , reside on either end of cavity  510 . Pressure elements  560  include outer sides  522  sloping towards ends  502  and  503 . Ends also include concave sections  507  with partial cavities  540 .