Pessary Insertion

PESSARY INSERTION REASON FOR VISIT: •Cystocele •Rectocele •Enterocele •Uterine prolapse •Stress incontinence

RISK ASSESSMENT •PID •Active pelvic infection •Diabetes PREPARATION OF THE PATIENT: Before procedure estrogen therapy was given to the patient ANESTHESIA: None POSITION OF THE PATIENT: Lithotomy Position THE PROCEDURE •Patient was in lithotomy position •Middle finger was inserted behind the cervix in the posterior fornix •Index finger was inserted against the pubic notch •The distance between 2 fingers was used as a starting point in pessary sizing.

•Fingers were withdrawn •Proper pessary ring was selected •The fitting ring was folded in half •Entering end was lightly lubricated •Pessary was inserted into the vagina so that part of the ring is behind the cervix and the opposite side is behind the pubic notch •Sweep finger around the perimeter of the ring to check for pressure points. DURATION ___________min AFTER CARE •To prevent infections and odours, an acidifier/ estrogen must be applied vaginally 2 or 3 times weekly. •Use oral/ transdermal estrogen/ an estradiol-17 ring •Remove and wash the pessary once in______ wks/months COMPLICATIONS •Vaginal infection •Erosions •Vaginal ulcer •Discharge •Odour •Pain •Bleeding •Failure to reduce the prolapse •Expulsion