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Microsoft word - pessary.doc

A pessary is a plastic de vice that fits into your vagina to help support your uterus (womb), vagina, bladder or rectum. The pessary is most often used for "prolapse" of the uterus or vagina. Prolapse means that the uterus or vagina droops or tends to "fall out" because it loses support. This problem can be fixed with surgery or you can use a pessary to help keep the uterus and vagina in place. A pessary can help if you have a "cystocele" (when your bladder droops down into your vagina) and in certain cases, if you have a "rectocele" (when your rectum sticks up into the bottom of your vagina). A pessary may also help women with stress urinary incontinence (the leaking of urine when you cough, strain or exercise). Pregnant women with incontinence can also use a pessary. First- and second-degree prolapse are usually managed with a ring pessary. The Gellhorn pessary is designed to manage severe uterine or vaginal prolapse. The Gellhorn pessary offers stronger support, but it is a little more difficult to remove than the ring pessary. After the first fitting, you'll need to return to have the pessary rechecked. Your doctor will check to be sure the pessary is not causing irritation to the vagina and will evaluate the fit of the pessary after you have worn it for a few days. After the follow up appointment, you will only need to return to be checked every few months. Sometimes the size or shape of the pessary will have to be changed over time. How do I care for my pessary?
If you feel comfortable placing and removing the pessary, you can remove it for cleaning every one to four weeks. The pessary can be cleaned with simple soap and water. Do not use detergents or antibacterial sprays because they may damage the pessary. If you are not comfortable placing and removing the pessary, you can be scheduled each month for evaluation. Your doctor or nurse will remove the pessary for cleaning then replace it for you. Image copyright 2004 by Nucleus Communications, Inc. All rights reserved. Over time you may notice the pessary becomes somewhat discolored. This is to be expected and does not mean the pessary is infected or will not work. Does the pessary cause any side effects?
You may notice more vaginal discharge than normal. Your vaginal discharge may also develop an odor. Vaginal estrogen cream can help with these side effects. The estrogen cream facilitates growth of the normal or “good” bacteria and prevents the growth of “bad” bacteria that can create odors. Good Vaginal irritation is another possible side effect. Women who are past menopause must use estrogen cream as directed by your doctor. This will prevent irritation and injury to the vagina. Can the pessary get lost or fall out?
The vagina is a closed tube. The pessary cannot go anywhere else inside the body. The pessary can fall out of the vagina if you strain or lift something. This usually means that your pessary is too small. Check with your doctor if your pessary keeps falling out. What else should I know?
Many pessaries can be worn during intercourse – your doctor will tell you if you can't. Be sure to tell your doctor promptly if you have any discomfort with the pessary, any vaginal bleeding, or if you have trouble urinating or having a bowel movement.

Source: http://www.pelvic-health-surgery.com/prolapse/prolapse/Pessary.pdf

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Microsoft word - clearing the decks.doc

You now know a lot more about stress and how it affects you (Part A & B of Week 1 handouts). The information in this section will help you to make changes that will put you in a better position to learn how to manage stress. Clearing the decks Before you learn new ways to get on top of stress, you must get rid of the things that might be making it worse. These may include: Alcoho

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