Pelvic Organ Prolapse & Pessaries: A Supportive Option That Can Help You Avoid Surgery
If you’ve been told you have pelvic organ prolapse, you may have immediately felt fear, embarrassment, or overwhelm. Many people assume prolapse automatically means surgery is inevitable. But the truth is, there are many conservative treatment options that can improve symptoms, restore confidence, and help you return to the activities you love.
One of the most underutilized and effective tools?
A pessary.
Before we get into all of the details, let’s talk about what prolapse is, how pessaries work, who they’re helpful for, and why combining a pessary with pelvic floor physical therapy can be a game-changer.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when one or more pelvic organs (such as the bladder, uterus, rectum, or vaginal walls) shift downward due to reduced support from the pelvic floor and surrounding connective tissue.
This can happen after:
pregnancy and childbirth
menopause (lower estrogen affects tissue support)
chronic constipation or straining
heavy lifting or repetitive pressure
genetics / connective tissue laxity
chronic coughing
hysterectomy or pelvic surgery
Prolapse is incredibly common- it affects about 1/2 of all women!
Common Prolapse Symptoms
Many people have prolapse without symptoms, but when symptoms do show up, they may include:
heaviness or pressure in the pelvis
feeling like something is “falling out”
a bulge in the vaginal area
urinary urgency or leaking
difficulty fully emptying the bladder
constipation or difficulty emptying the bowels
discomfort with exercise or prolonged standing
discomfort during sex
Here’s the key: symptoms matter more than the stage or grade.
Someone can have a higher-grade prolapse with minimal symptoms—or a mild prolapse with significant discomfort.
What Is a Pessary?
A pessary is a removable medical device, typically made of silicone, that is placed inside the vagina to help support pelvic organs.
Think of it like a sports bra for the pelvic organs, or maybe like a little shelf for them to set on.
It doesn’t “fix” prolapse permanently, but it can:
provide support
reduce symptoms
improve comfort with daily life and exercise
reduce strain on pelvic tissues
Many people wear a pessary for years with excellent success.
How Can a Pessary Help Prolapse Symptoms?
A pessary can be incredibly effective for symptom relief, including:
Reducing Pressure and Heaviness:
This is the #1 reason most people love their pessary. Many describe an immediate feeling of “lift” or relief.
Improving Bladder Symptoms
If prolapse is affecting the bladder, a pessary may reduce urinary urgency, incomplete emptying, urinary frequency. stress urinary leakage (especially with coughing or jumping)
Improving Bowel Function
Certain types of prolapse can contribute to bowel difficulty. A pessary may improve the feeling of incomplete emptying or reduce the need to strain.
Supporting Activity and Exercise
Many women stop running, lifting, hiking, or even walking long distances due to prolapse symptoms. A pessary can help people return to fitness safely and confidently.
Reducing Irritation or Bulging
If you’re feeling or seeing a bulge, a pessary can reduce that sensation significantly.
When Is a Pessary Most Helpful?
A pessary can be a great option if you:
want symptom relief without surgery
are postpartum and want to give your body time to recover
are in menopause and noticing increasing symptoms
want to stay active (lifting, hiking, running, sports)
have symptoms that worsen later in the day
are not a surgical candidate due to health factors
want to delay surgery until the “right time”
want to see if symptom relief improves quality of life before choosing surgery
are trying to manage prolapse while caring for young kids or a demanding job
Some people use a pessary daily. Others only use it during workouts, travel, or long days on their feet.
Can a Pessary Help Prevent Surgery?
For many people, yes.
While a pessary does not “reverse” prolapse permanently, it can:
significantly reduce symptoms
reduce tissue strain over time
allow continued activity without worsening symptoms
help manage prolapse long-term
Many patients who planned surgery end up realizing they can live comfortably without it once they find the right pessary fit and learn proper pelvic floor strategies.
And for those who eventually do choose surgery, using a pessary and pelvic floor PT beforehand often improves overall pelvic health and recovery.
Does Wearing a Pessary Mean Your Pelvic Floor Is Weak?
Not necessarily. Prolapse is not just about “weak muscles.” It’s often about:
tissue elasticity
pressure management
hormonal changes
coordination and endurance of the pelvic floor
abdominal and breathing mechanics
lifestyle factors (constipation, lifting habits, etc.)
A pessary is simply a tool to help support the tissues while you work on long-term improvement.
Pessary + Pelvic Floor Physical Therapy: The Best Combination
This is where outcomes get even better.
Pelvic floor physical therapy can help you:
Build strength and endurance so the pelvic floor can better support you through daily movement and exercise.
Improve pressure management and learn how to breathe and lift properly reduces strain on the pelvic floor and prolapse.
Improve coordination- many people with prolapse actually have pelvic floor muscles that are overactive or uncoordinated- not just weak.
Address Constipation: Bowel habits and straining are major prolapse triggers. PT can help improve bowel mechanics and pelvic floor relaxation.
Support Safe Return to Fitness- especially if you want to lift weights, run, or do high-impact exercise.
Improve Sexual Function: Pelvic floor PT can improve comfort, confidence, and circulation to tissues.
A pessary supports you now.
Physical therapy helps your body support itself long-term.
That’s why the combination often leads to the best outcomes.
What Is It Like to Get Fit for a Pessary?
Pessaries are typically fit by:
an OB/GYN
urogynecologist
some pelvic PTs- Like your pelvic PT at Breeze Pelvic Health
During a fitting, different sizes and shapes are tried to find the one that:
stays in place comfortably
reduces symptoms
allows you to pee and move normally
doesn’t cause pain
Most people are surprised at how comfortable the correct pessary feels.
A good pessary fit should feel like nothing at all.
Are Pessaries Safe? Yes. Pessaries have been used for decades and are considered very safe when monitored appropriately.
Some people remove and clean them themselves. Others prefer to have their provider manage it at follow-up visits.
Your provider will also recommend follow-ups to monitor vaginal tissue health.
In some cases, especially during menopause, vaginal estrogen may be recommended to keep tissue healthy and reduce irritation.
Who Should Not Use a Pessary?
A pessary may not be the best fit if:
there are unresolved vaginal infections or severe irritation
vaginal tissue is extremely fragile and painful
it cannot stay in place despite proper fitting
the person is unable to manage cleaning/follow-up and doesn’t have support
However, many people who assume they “aren’t a good candidate” actually do great once they find the correct type and size.
Prolapse Has Options
If you have prolapse, you are not alone, and you are not out of options.
A pessary can be a powerful tool to:
reduce symptoms
support your organs
improve comfort during exercise
help you avoid or delay surgery
improve quality of life
And when paired with pelvic floor physical therapy, outcomes are often excellent.
Need Help Navigating Prolapse Treatment?
If you’re experiencing pelvic pressure, heaviness, bulging, or changes in bladder or bowel function, pelvic floor physical therapy can help you understand what’s happening and create a plan that supports your body and your goals.
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