Pessaries: A Simple, Nonsurgical Option for Pelvic Organ Prolapse and Bladder Leakage
If you have ever felt vaginal pressure, heaviness, or a bulge—especially after being on your feet, exercising, lifting, or having a baby—you may have wondered whether pelvic organ prolapse is part of the problem. You may also have been told to “just do Kegels” or that surgery is your only option.
But there is another tool many women have never been told about: a pessary.
A pessary is a removable medical device worn inside the vagina to support the pelvic organs. Think of it as a supportive brace for the pelvic floor. It can reduce prolapse symptoms, help some types of bladder leakage, and make daily movement or exercise feel more comfortable—without surgery.
Core Pelvic Health and Wellness is now offering pessary fittings in our clinic.
First, what is pelvic organ prolapse?
The pelvic floor is made up of muscles, connective tissue, and ligaments that help support the bladder, uterus, vagina, and rectum. Pelvic organ prolapse, or POP, occurs when that support system becomes less effective and one or more pelvic organs descend toward or into the vaginal canal.
Different areas can be involved:
Anterior vaginal wall prolapse: The bladder presses into the front vaginal wall. You may hear this called a cystocele.
Posterior vaginal wall prolapse: The rectum presses into the back vaginal wall. This is often called a rectocele.
Uterine or apical prolapse: The uterus or the top of the vagina descends. After a hysterectomy, the top of the vagina can also lose support; this is called vaginal vault prolapse.
Some women have more than one type at the same time.
What does prolapse feel like?
Prolapse does not feel the same for everyone. In fact, some women have measurable prolapse and no symptoms at all. Others experience significant symptoms even when the prolapse is not considered advanced.
Common symptoms may include:
Vaginal heaviness, pressure, or a dragging sensation
Feeling or seeing a bulge at the vaginal opening
Feeling as though a tampon is falling out
Symptoms that worsen later in the day, after prolonged standing, or with exercise
Difficulty emptying the bladder or bowel completely
Urinary urgency, frequency, or leakage
Needing to change position or press on the vaginal wall to have a bowel movement
Discomfort with intercourse
Avoiding exercise, lifting, travel, or daily activities because of pressure or fear
Symptoms—and how much they affect your life—matter just as much as the prolapse stage.
Understanding the stages of prolapse
Clinicians commonly use the Pelvic Organ Prolapse Quantification system, or POP-Q, to describe how far the vaginal walls or apex descend in relation to the vaginal opening, called the hymen.
Stage 0: No prolapse is present.
Stage 1: The prolapse remains well inside the vagina.
Stage 2: The leading edge is close to the vaginal opening—within approximately 1 centimeter above or below it.
Stage 3: The prolapse extends more than 1 centimeter beyond the vaginal opening, but the vagina is not completely everted.
Stage 4: The prolapse is essentially completely everted.
A higher stage does not automatically mean more pain, more symptoms, or a need for surgery. Treatment decisions should be based on your symptoms, goals, health history, and preferences—not the stage alone.
What is a pessary?
A pessary is usually made from medical-grade silicone. It is inserted into the vagina and positioned to support the vaginal walls and pelvic organs. It does not permanently change your anatomy, and it is not the same as surgical mesh.
When properly fitted, you generally should not feel it during normal daily activity. You should also be able to urinate and have a bowel movement without difficulty. Some pessaries can be removed and reinserted at home, while others are more commonly managed during scheduled office visits.
Pessaries come in different sizes and shapes because bodies—and support needs—are different. It may take more than one trial to find the option that feels comfortable, stays in place, and adequately reduces symptoms.
Common types of pessaries
Pessaries generally fall into two broad categories: support pessaries and space-filling pessaries.
Ring pessary
The ring is one of the most commonly used options. It is flexible, is often easier to insert and remove, and may be helpful for mild to moderate prolapse. Many women can learn to manage it independently.
Ring with support
This looks similar to a standard ring but has a supportive membrane across the center. It can offer additional support for the vaginal walls.
Incontinence ring or incontinence dish
These pessaries include a small raised area that supports the urethra. They may be used for stress urinary incontinence—leakage with coughing, sneezing, running, jumping, or lifting—with or without prolapse.
Gellhorn pessary
The Gellhorn provides stronger support and may be helpful for more advanced prolapse. It can be more difficult to remove and reinsert independently, so office management is often needed.
Cube pessary
The cube uses gentle suction against the vaginal walls and may be considered when other pessaries do not stay in place or when stronger support is needed. It generally requires regular removal and cleaning and is often removed nightly.
Other shapes are available, and the “best” pessary is not determined by stage alone. Your anatomy, tissue health, symptoms, activity goals, comfort, hand dexterity, and ability or desire to manage the device at home all matter.
Who may benefit from a pessary?
A pessary may be helpful if you:
Have vaginal pressure, heaviness, or a bulge related to prolapse
Want a nonsurgical treatment option
Want to delay surgery or are not a candidate for surgery
Need symptom support while participating in pelvic floor rehabilitation
Notice more pressure with running, strength training, work, travel, or prolonged standing
Experience stress urinary leakage with coughing, sneezing, lifting, running, or jumping
Want support during a specific activity rather than all-day use
Are pregnant or postpartum and need individualized support
Pessaries are not only for older women and are not reserved for severe prolapse. They may be used by active women, postpartum women, women who have never given birth, and women at many stages of life.
What about pessary use early postpartum?
This is an exciting and developing area of pelvic-health research.
During pregnancy and birth, the pelvic floor and its connective tissues experience significant load and stretch. In the early months after delivery, some women notice heaviness, bulging, urinary leakage, or reduced pelvic support. Traditionally, postpartum care has emphasized time, activity modification, and pelvic floor rehabilitation. Newer research is exploring whether a postpartum-specific pessary can provide additional support during this recovery period.
Recent prospective studies have found that beginning a specifically designed postpartum pessary around six weeks after birth appears feasible for many women. Women who used the device reported greater improvement in pelvic-floor symptom scores over time, including symptoms related to prolapse and urinary or bowel function. A randomized study also found pessary use more effective than standard care or pelvic floor muscle training alone for reducing postpartum urinary-incontinence symptoms during the study period.
These findings are encouraging, but they do not yet prove that early pessary use prevents long-term prolapse or permanently restores pelvic-floor anatomy. Some studies were observational, women chose whether to use the device, adherence varied, and the research has focused on particular postpartum pessary designs. More high-quality research is needed before early postpartum pessary use can be considered routine care for everyone.
The practical takeaway: a pessary may be a useful symptom-management and activity-support tool for selected postpartum women, but it should be recommended and fitted based on an individualized assessment rather than used as a one-size-fits-all “preventive” device.
Is a pessary a replacement for pelvic floor therapy?
Usually, no—and we do not see it that way.
A pessary can provide mechanical support, but it does not address every factor contributing to symptoms. Pelvic floor therapy can help evaluate and improve:
Pelvic floor muscle strength, endurance, coordination, and the ability to relax
Breathing and pressure management
Constipation and bowel mechanics
Lifting, running, and exercise strategies
Hip, trunk, and whole-body strength
Confidence with returning to meaningful activity
For many women, the most effective plan may combine a pessary with pelvic floor therapy. The pessary reduces symptoms while therapy helps improve how the entire system manages pressure and load. The goal is not simply to “hold everything up.” It is to help you move, exercise, work, care for your family, and live with greater comfort and confidence.
What happens during a pessary fitting?
A fitting begins with a conversation about your symptoms, medical history, goals, and whether you want to manage the pessary yourself. A vaginal examination helps determine the type and size most likely to work for you.
Once a pessary is inserted, we assess whether it:
Feels comfortable
Remains in place with movement and bearing down
Reduces your symptoms
Allows you to empty your bladder and bowel normally
Supports the activities that matter to you
You will also receive instructions for insertion and removal when appropriate, cleaning, wear schedule, follow-up, and signs that the fit needs to be reassessed.
An increase in discharge can occur with pessary use. Contact your provider if you experience pain, new vaginal bleeding, foul-smelling discharge, difficulty urinating or having a bowel movement, or if the pessary repeatedly falls out. Regular follow-up helps protect vaginal tissue health and ensures the device continues to fit appropriately.
A new option is coming to Core
We are excited to begin offering pessary fittings at Core Pelvic Health and Wellness as part of our individualized, whole-body approach to pelvic health.
Our goal is not to hand you a device and send you on your way. We want to help you understand what is contributing to your symptoms, determine whether a pessary fits your goals, find an appropriate type and size, and integrate it into a broader plan for strength, movement, and long-term pelvic health.
If you are experiencing vaginal pressure, heaviness, a bulge, or bladder leakage—or if you are curious whether a pessary could help you return to exercise or feel more supported postpartum—contact our clinic to schedule an evaluation or join our pessary-fitting interest list.
You have options. Prolapse does not automatically mean surgery, and it does not have to mean giving up the activities you love.
This article is for educational purposes and is not a substitute for an individualized medical examination or diagnosis. New vaginal bleeding, difficulty emptying the bladder, severe pain, or concerning postpartum symptoms should be assessed promptly by an appropriate healthcare professional.
References and further reading
American Urogynecologic Society and Society of Urologic Nurses and Associates. Joint Clinical Consensus Statement: Vaginal Pessary Use and Management for Pelvic Organ Prolapse (2022).
Beer F, et al. Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study (2024).
Kiefner B, et al. Evaluating compliance and applicability of postpartum pessary use for preventing and treating pelvic floor dysfunction (2023).
Lange S, et al. Comparison of vaginal pessaries to standard care or pelvic floor muscle training for treating postpartum urinary incontinence: a randomized controlled trial (2024).
American Urogynecologic Society, Voices for PFD. Pelvic Organ Prolapse FAQs.
