Pessary for Prolapse: Ultimate Guide to Uses & Care

You’re avoiding certain activities out of fear of making that uncomfortable heaviness or dragging sensation in your pelvis worse. You leak when you laugh, cough, or sneeze, and you find yourself planning your day around the nearest bathroom. You start second-guessing every movement and activity – afraid to run or jump, and even playing with your children feels off limits. It’s more than an inconvenience – it affects your confidence, your energy, and your ability to experience life fully. And you’re definitely not alone.

For many women living with pelvic organ prolapse or urinary incontinence, the impact goes far beyond physical discomfort or the daily annoyance that comes with it. A pessary can offer immediate symptom relief – this small, flexible device gently supports your pelvic organs so you can move, lift, laugh, and live with more comfort and confidence. There’s no surgery, no recovery time, and nothing permanent – just a simple solution that helps you feel more like yourself again.

Once thought to be only for older women, pessaries are now used by people of all ages – from new mothers in postpartum recovery to athletes who use them proactively to support the pelvic floor during high-impact activities, and active women who want to continue doing what they love without worry and with a greater sense of control and renewed comfort and confidence in their bodies.

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Table of Contents

What is a Pessary?

A pessary is a flexible, removable device (usually made of silicone, rubber or PVC plastic) that your healthcare provider fits inside your vagina. It acts like a support cushion, holding up your bladder, uterus, or bowel so they don’t press downward and cause pelvic organ prolapse symptoms. It can be self-managed or managed by your medical practitioner for removal and cleaning.

“Pelvic organs, such as the uterus, bladder or bowel, may protrude into the vagina because of weakness in the tissues that normally support them. This protrusion is known as pelvic organ prolapse. Women who experience prolapse report a wide variety of symptoms that affect their quality of life. The choice of treatment options for pelvic organ prolapse symptoms is dictated largely by patient choice, as the interventions of lifestyle changes, pelvic floor muscle training (PFMT), pessary and surgery are very different with different complication risks. Vaginal pessaries are one treatment option for prolapse that are commonly used to restore the prolapsed organs to their normal position and hence relieve symptoms. A vaginal pessary can be used to treat all four prolapse stages [1].”

How a Pessary Works to Support the Pelvic Floor

A pessary is inserted into the vagina, where it sits comfortably to support the bladder, uterus, or rectum, depending on your needs. Placement and positioning vary with the type of pessary – for example, a ring pessary sits horizontally behind the pubic bone. In contrast, cube or Gellhorn pessaries rely on gentle suction or pressure to stay in place. Once fitted properly, you shouldn’t feel it at all.

No surgery, no anesthesia, no recovery, and fully reversible
Affordable and widely accessible
Immediate support: Many women feel relief and improved pelvic support as soon as the pessary is in place
Encourages natural pelvic alignment
Urethral support: Immediately controls urinary stress incontinence
Acts as a splint to aid bladder and bowel emptying
Toilet: No need to remove a pessary when emptying the bladder and bowels
Supports independence and freedom: Allows you to manage your prolapse confidently and continue normal activities, including daily activities, exercise, and travel
You are in control: Can be removed and reinserted as needed for comfort and support

Every body is unique, and finding the right pessary can take a little trial and error. Comfort, proper fit, and regular check-ins with your provider make all the difference between a frustrating experience and one that feels supportive and empowering.

How well do Pessaries Work?

While a pessary may not be suitable for everyone due to individual needs and medical considerations, many women experience a significantly improved quality of life once they find one that fits well and feels comfortable.

Fitting success: Clinical studies vary in percentages, but we can average them out to 41% – 86% success rates [2-5].

Symptom relief: A well-fitted pessary often provides noticeable relief – decreased pressure or bulge sensation, less leaking, less back pain, and greater comfort, confidence, and overall quality of life.

Pessary for urinary incontinence: A pessary for urinary incontinence supports the urethra. It has been demonstrated in many trials that the episodes of leaking reduce significantly, and also being totally dry with the pessary.

Ease of Use: Most pessaries are easy to manage independently. However, regular check-ups are still essential to ensure your vaginal tissues remain healthy. Follow your healthcare provider’s advice on how often to be examined.

Who can benefit from a Pessary?

Women who feel a “bulge” or heaviness in their vagina
Those who leak urine when lifting, coughing, sneezing, or exercising
Anyone who wants to avoid or delay surgery for pelvic organ prolapse or incontinence
Those who have had abdominal surgery and wish to support the pelvic organs
Women who do sports, fitness training, and feel they may need extra support

At-Home Care

Cleaning, Storage, & Annual Check-ups

Many women choose to learn how to remove, clean, and reinsert their pessary at home. Your provider can teach you how to do this safely and confidently
Always ensure you insert a clean pessary only using water-based lubricant
Do not use any oils or silicone lubricants on pessaries
Follow the manufacturer’s or your healthcare provider’s recommendations for how often the pessary should be removed
Cleaning your pessary: use non-perfumed soap and rinse under clean running water, or boil in clean water for 5 to 10 minutes (do not boil the inflatable donut). Use a baby toothbrush or interdental brush to clean pessaries with drainage holes
NEVER wipe your washed pessary with a towel or tissue paper, air dry only
Some discoloration over time is expected and does not mean it’s unclean
When not in use, store your pessary in a clean container away from humidity, and remember to wash it before inserting it
Schedule an annual exam or sooner if needed with your healthcare provider to assess vaginal tissue health

With proper cleaning and maintenance, most silicone pessaries have a lifespan of approximately five years. Devices made from other materials are typically less durable and will need to be replaced more frequently. Always follow manufacturer recommendations for specific care and replacement intervals.

Take simple steps toward regaining your ability to do the things you love

Pessary Insertion and Removal

Pessary Insertion Basics:

Ensure your hands and pessary are washed if you are self-managing
Find a position which is comfortable and convenient for you or your healthcare provider to insert the pessary
Take a few moments to focus on your breath. Gentle, intentional breathing – especially slow exhales – can help calm your nervous system and encourage the pelvic floor to relax
Apply water-based lubricant into the vagina and onto the pessary. Make sure you push back the prolapse before inserting your pessary, which gives the pessary a better chance to support the prolapse effectively when standing

Pessary Removal Basics:

Clean hands
Find a comfortable position: if lying down, place a pillow under the pelvis; if standing, come into a soft knee bend squat
For any pessary with an integrated string, do not pull on the string to remove
For any pessary that creates suction, it is essential to break the suction before removal
Reach in with your index finger and gently bring the pessary down the vaginal canal.
Remember to focus on your breathing and relaxing the pelvic floor muscles
Tip: If the pessary is difficult to remove, gently cough as you remove the pessary

Key Points to Remember:

Discomfort: A small number of women may feel some discomfort when first using a pessary. This is typically mild and should resolve within 24 hours. If discomfort is severe or persistent, remove the pessary and contact your healthcare provider
Increased Vaginal Discharge: Some increase in discharge is normal. However, if the discharge has an unpleasant or unusual odour or appears green, remove the pessary and contact your healthcare provider for advice
Complications: Although extremely rare, complications have been documented when pessaries are left in place for longer than the recommended time. Complications can occur when there is a vaginal infection and the pessary is not removed
Movement Matters: Your daily movement patterns can affect how well your pessary stays in place. Many women find that combining pessary use with a movement program like Restore Your Core® helps them develop better body mechanics and pelvic floor awareness, leading to more successful long-term pessary use
Regular Check-ups: Your healthcare provider will determine the appropriate timing for your next follow-up appointment. If you have a history of vaginal atrophy or erosion, more frequent reviews – typically every 3 to 6 months – may be recommended to allow for pessary cleaning, assessment of device fit, and examination of vaginal tissues. In the absence of such concerns, an annual review may be sufficient. However, if you notice any new or unusual symptoms – such as pain, bleeding, or malodorous discharge – you should contact your healthcare provider promptly for further assessment
Symptom Diary: Keeping a simple symptom diary can be a great way to track how your body responds to your pessary over time. Note any changes in comfort, leakage, discharge, or sensations of pressure. This can help you and your healthcare provider make informed decisions about fit, follow-up timing, or adjustments.

Types of Pessaries

Pessaries are generally categorized into 3 main groups. The following pessaries are suitable for self-management:

Support pessaries
Occult (space-filling pessaries)
Lever pessaries

Pessaries are primarily used for support, but categorizing them can help clarify their purposes. One of the key questions a clinician should ask is whether the patient is sexually active, as this will influence the choice of pessary. It’s important not to assume that women over a certain age stop being sexually active – many women well into their 80s continue to enjoy an active and fulfilling sex life!

Additionally, if a patient plans to use a vaginal toning device, vaginal dilator or vibrator, this should be discussed with the clinician, as it will also impact the type of pessary recommended. The clinician will need to ensure that the patient is taught how to properly insert, remove, and care for the pessary.

A space-filling pessary is also referred to as an occult pessary. These pessaries take up significant vaginal space and fit deeply into the vagina to offer support to more severe prolapses or multiple prolapses. These pessaries need to be removed prior to any kind of penetration: intercourse, dilator use, or vibrator use. It’s important you let your healthcare provider know if you are sexually active or using any vaginal penetration aids so they can help you choose a pessary that suits both your lifestyle and pelvic health needs.

Some support pessaries, such as the ring without support, the oval without support, and the dish without support, can be left in during sexual activity.

A lever pessary is a type of vaginal device that can help manage certain conditions, such as stress incontinence or a tilted (retroverted) uterus, or in some cases, it is used during pregnancy.

Lever pessaries contain a small amount of metal inside, so it’s important to let your healthcare provider know if you’re having a scan, like an MRI or ultrasound. The pessary will usually need to be removed before the scan to make sure the images are clear and accurate.

Pregnancy Specific Pessary

The cerclage pessary is not included in the three general categories, as it is specifically designed for use during pregnancy. The cerclage pessary is a silicone device specifically designed for use during pregnancy as an alternative to a cervical cerclage suture. It is used to help reduce the risk of preterm birth by supporting the cervix and maintaining its closure. The insertion and removal of a cerclage pessary must be performed exclusively by a certified obstetrician-gynecologist, given the need for careful assessment and proper placement during an ongoing pregnancy.

Pessary Types at a Glance

Each pessary type is available in a range of sizes to accommodate individual anatomical differences. Your provider will help determine the right shape and size for you to ensure comfort and optimal support.

Pessary Type	Best For	Self Managed	Intercourse Possible	Highlights
Ring With knob	Everyday support, mild pressure Stress incontinence	Yes	Yes, without support membrane	Lightweight, flexible *Not always suitable for rectocele
Gellhorn	Stronger support needed	Difficult	No	Holds shape well
Shaatz	Stronger support needed	Yes	No	Holds shape well. Good alternative to the ring
Pre-Inflated Donut Self-Inflatable Donut	Full support for significant pressure Full support	No Yes (Daily care	No No	Non-self-managing. Fills space comfortably Self managing
Cube	Deep suction for dynamic support	Yes (Daily Care)	No	Strong hold
T Pessary	Stress incontinence and mild anterior and posterior pressure	Yes (Daily care)	No	Supports stress incontinence well
Hodge/Risser/Smith	Stress incontinence, retroverted uterus, pregnancy	No	Yes	Contains metal and needs removal before a scan
Marland	Mild-Moderate prolapses	Yes	Yes, without support membrane	Can support multiple prolapses
Gehrung	Mild-Moderate prolapses	Yes but difficult	Yes	Can support multiple prolapses. Contains metal and must be removed before a scan
Dish	Mild – moderate support	Yes	Yes, without support membrane	Good option for rectocele
Cerclage	Pregnancy	No must be managed by a doctor	This must be discussed with the doctor	For an incompetent cervix and prevention of preterm birth
Oval	Mild-Moderate prolapses	Yes	Yes, without support membrane	Good for scar tissue issues
Reia	Mild-severe prolapses	Yes	No	For all types and multiple prolapses

How to Find and Fit a Pessary for Prolapse

A pessary can be a game-changer for pelvic organ support – but only if it fits you. Don’t give up on pessaries just because the first one feels uncomfortable or doesn’t stay in place.

Always consult a medical professional to discuss which type of pessary will work best for you
Always be professionally measured
Discuss your lifestyle with your medical provider, as this can influence the type of pessary
You may find that two different types will serve you well throughout the day, depending on your activities

Common Reasons for an Uncomfortable or Ineffective Pessary Experience

Incorrect size or shape for your unique anatomy
Movement patterns and pressure management: How you move and breathe impacts intra-abdominal pressure and influences how well your pessary stays in place
Nerve damage: your pessary may be pressing on a nerve, causing discomfort

Our bodies naturally adopt “shortcut” patterns – muscles and fascia learn the easiest way to move. Over time, these habits can pull you out of optimal alignment and undermine pelvic floor support. The good news? Fascia and muscle “memory” work both ways. Through guided retraining with Restore Your Core®, you can repattern your body for better pelvic health.

Understanding Pessary Uses

Pessary for Prolapse	Uterine Prolapse	Cystocele (Bladder Prolapse)	Rectocele	Combined Support	Stress Incontinence
Ring	✔️	✔️			✔️
Ring with Knob	✔️	✔️			✔️
Oval	✔️	✔️			✔️
SomaFlex	✔️	✔️	✔️	✔️	✔️
Hodge-Levers	✔️	✔️
Hodge-Levers with Knob		✔️			✔️
Inflatable	✔️	✔️	✔️	✔️
Gehrung	✔️	✔️	✔️	✔️
Donut	✔️	✔️	✔️	✔️
Cube	✔️	✔️	✔️	✔️	✔️
Gelllhorn	✔️	✔️
Shelf				✔️
Cup	✔️	✔️			✔️
Dish	✔️	✔️	✔️	✔️
Dish with Knob	✔️	✔️	✔️	✔️	✔️
Marland	✔️	✔️	✔️	✔️	✔️
Shaatz	✔️
T Pessary		✔️	✔️		✔️
Contam		✔️	✔️	✔️	✔️
Reia	✔️	✔️	✔️	✔️	✔️
Dr. Arabin Hybrid	✔️	✔️
Provate	✔️				✔️
Uresta	✔️				✔️
Poise Impressa					✔️
Contrelle					✔️
Efemia					✔️
Revive					✔️
Urethral Ring	✔️	✔️			✔️
Restifem	✔️	✔️	✔️		✔️

Note: This chart reflects the most current information available as of November 2025, but pessary technology and clinical guidance continue to evolve. As new research emerges and additional designs become available, recommendations may change. Always consult your healthcare provider or refer to the manufacturer’s guidelines for the most up-to-date information.

Disclaimer:
This chart is intended for general information and does not constitute medical advice. Pessary suitability depends on individual anatomy, symptoms, and manufacturer guidelines. Always discuss options with a qualified provider.

Some pessaries may be used beyond the manufacturer’s labeled indications. This is common in clinical practice and should involve informed consent and close follow-up.

Key Points:

Pessaries with a knob are typically designed for support of the anterior wall/bladder/urethral.
Specific pessary designs (e.g., the ring with support) can provide additional support across multiple pelvic compartments.
Don’t rule out a device solely because it isn’t listed for your exact scenario – provider guidance and trial fittings are the best way to identify the most suitable option for your individual anatomy.

Discover the top steps toward managing your prolapse with confidence

Do I need to have a Uterine Prolapse or Urinary Incontinence to benefit from a Pessary?

Not at all! Research indicates that stress incontinence affects up to 75.6% of athletes in high-impact sports such as volleyball [6]. Pessaries aren’t only for those with diagnosed prolapse or incontinence – they can also provide temporary pelvic floor support during activities that increase pressure, like running and jumping. Think of it as giving your pelvic floor an extra layer of support when it needs it the most!

Can I Exercise with a Pessary?

Absolutely!

In fact, the right pessary can:

Support pelvic organs so you can engage your core and pelvic floor more effectively
Help you move with greater comfort and confidence
Reduce sensations of heaviness or pressure during activity
Prevent leaks
Allow you to return to activities like walking, lifting, or running with more ease

Whether you’re walking, practicing the Restore Your Core® online program, or returning to higher-impact fitness, a well-fitted pessary can support your pelvic floor and help you focus on your workout – not your symptoms.

How does Restore Your Core® Help Prolapse?

Restore Your Core® is a proven movement program designed to retrain your body’s foundation for better pelvic and core support. The program helps you:

Identify and change habitual movement and posture patterns that contribute to pelvic floor strain
Rebuild balanced strength and flexibility through whole-body exercises
Improve breath mechanics and manage intra-abdominal pressure to reduce downward load on the pelvic floor

When used alongside a pessary, RYC® helps create the alignment, coordination, and pressure management needed for the pessary to stay comfortably in place and do its job effectively. Many participants find that integrating these principles transforms a past “failed” pessary experience into one of comfort and renewed confidence.

When to Reassess Your Pessary Fit

Don’t settle for a pessary that doesn’t feel right. Comfort is key – your pessary should never cause pain, pressure, or irritation. If you experience discomfort, notice it slipping out of place, or find that it no longer provides the same level of support, it’s time to check in with your healthcare provider.

A re-fit may be needed if you’ve experienced:

Changes in comfort or pressure during daily activity or exercise
Slipping or shifting, especially when walking, exercising, coughing, or using the toilet
New spotting, discharge, or irritation inside the vagina
Body changes, such as postpartum recovery, perimenopause, or weight fluctuations, can alter tissue tone and pelvic support

Pessary fit isn’t always a one-and-done – it’s a process that evolves with your body. Regular follow-ups help ensure your device continues to feel comfortable and offer effective support. With the right fit, guidance, and supportive movement practice, you can restore pelvic floor balance and move through life with confidence and freedom.

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FAQ

1. What is a pessary for prolapse?

A pessary is a safe, removable device inserted into the vagina to support the pelvic floor and organs, helping to manage mild to advanced pelvic organ prolapse and relieve associated symptoms such as pelvic pressure and urinary incontinence.

A healthcare professional determines the correct size and type after a pelvic examination. In many cases, the patient can then be taught to manage and care for it independently.

2. Can I exercise with a pessary?

Yes, in fact, using a pessary can make pelvic floor muscle training (PFMT) more effective for people with pelvic organ prolapse (POP). With the pessary in place, the pelvic organs are lifted, reducing pressure on the pelvic floor muscles and allowing them to work from their optimal position. This can help the muscles contract more efficiently and strengthen properly.

A pessary also creates space for the muscles to move through their full range, and over time, it may help the nervous system adapt to the organs being in the correct position, supporting long-term improvement.

3. Is wearing a pessary comfortable?

Yes, a pessary should feel comfortable when correctly fitted. It’s normal to be aware of the pessary at first as your body adjusts to it, but this sensation usually fades. Most people do not feel the pessary at all during daily activities. If you experience ongoing discomfort, pain, or pressure, the pessary may be the wrong size or type; in this case, you should consult your healthcare provider.

Occasionally, tension in one area of the pelvic floor can cause discomfort in another, which may also make the pessary feel uncomfortable. In such cases, pelvic floor assessment and relaxation techniques, and exercises can be beneficial.

4. How often should I clean my pessary?

Every time the pessary is removed.

5. Can I be sexually active while wearing a pessary?

With certain types of pessaries, full penetration is indeed achievable. With space-filling pessaries or occult pessaries, there is no space for penetration, but clitoral stimulation can be achieved when wearing any type of pessary. Please check the chart of pessaries.

6. How often should a pessary be removed?

It depends on the type of pessary and your provider’s guidance. Some can stay in place for several months, while others should be removed and cleaned daily.

7. What if my pessary feels uncomfortable or falls out?

If your pessary feels uncomfortable or falls out, it may not be the right size, shape, or fit for your body. This is a common issue, especially in the early stages of finding the correct pessary.

Changes in body weight, pelvic floor muscle tone, or hormone levels can also affect how well the pessary fits over time. Contact your healthcare professional if you experience these issues – they can help find a better fit to ensure the pessary remains effective and comfortable.

References

[1] Bugge, C., Adams, E. J., Gopinath, D., Stewart, F., Dembinsky, M., Sobiesuo, P., & Kearney, R. (2020). Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 2020(11), Article CD004010.

[2] Donnelly, M. J., Powell-Morgan, S., Olsen, A. L., & Nygaard, I. E. (2004). Vaginal pessaries for the management of stress and mixed urinary incontinence. International Urogynecology Journal and Pelvic Floor Dysfunction, 15(5), 302–307.

[3] Clemons, J. L., Aguilar, V. C., Tillinghast, T. A., Jackson, N. D., & Myers, D. L. (2004). Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. American Journal of Obstetrics and Gynecology, 190(4), 1025–1029.

[4] Fernando, R. J., Thakar, R., Sultan, A. H., Shah, S. M., & Jones, P. W. (2006). Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstetrics & Gynecology, 108(1), 93–99.

[5] Al-Shaikh, G., Syed, S., Osman, S., Bogis, A., & Al-Badr, A. (2018). Pessary use in stress urinary incontinence: A review of advantages, complications, patient satisfaction, and quality of life. International Journal of Women’s Health, 10, 195–201.

[6] Pires, T., Pires, P., Moreira, H., & Viana, R. (2020). Prevalence of urinary incontinence in high-impact sport athletes: A systematic review and meta-analysis. Journal of Human Kinetics, 73, 279–288.

[7] Farrell, S. A., Baydock, S., Amir, B., & Fanning, C. (2007). Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women. American Journal of Obstetrics and Gynecology, 196(5), 474.e1–474.e8.