Pessary Too Big or Too Small? Signs Your Size Is Off and How to Pick the Next Size

You have your pessary in, but something feels off. Maybe it slips when you sneeze. Maybe it aches by the end of the day. You may be wondering: is this normal, or is it the wrong size?

This guide walks through the common signs that a ring pessary is too big or too small, what a good fit should feel like, and how to choose the next size with your clinician. It is written for women who wear a pessary and for daughters and caregivers who help them.

This article is general information. It does not replace an exam or advice from your own doctor, nurse practitioner or pelvic floor therapist.

What a good fit should feel like

When a ring pessary fits well, you usually forget it is there. You should be able to sit, stand, walk, bend and squat without feeling it. It should stay put when you cough or bear down, and you should be able to pass urine and stool normally.

Clinicians check fit in a few simple ways. A clinical review in American Family Physician explains that the examiner's finger should pass easily between the pessary and the vaginal wall. You may be asked to stand, sit, squat and bear down to make sure it does not move, and to pass urine before you leave the office. A guide from Australia's O&G Magazine adds that, once in place, the pessary should be comfortable.

The same AFP review notes that the largest pessary a woman can wear comfortably is generally the most effective. That is why fit is a balance: big enough to stay in and hold things up, but not so big that it presses or hurts.

Signs your pessary may be too big

A pessary that is too large can press on the vaginal walls, the bladder opening or the rectum. Signs include:

• Pressure or aching that does not settle after the first day or two.
• Cramping or a feeling of fullness low in the belly.
• Trouble peeing: hard to start, a weak stream, or a feeling that your bladder has not emptied.
• Trouble with bowel movements or a new feeling of blockage.
• Soreness, spotting or bleeding, which can mean the ring is rubbing.

Trouble passing urine is the one to take most seriously. The AFP review says that if a woman cannot pass urine with the pessary in place, it should be removed and the next smaller size fitted.

Signs your pessary may be too small

A pessary that is too small does not have enough to rest against, so it moves. Signs include:

• It slides down toward the opening, or you can feel it near the entrance.
• It falls out when you cough, sneeze, lift or have a bowel movement.
• It twists or turns sideways. O&G Magazine notes that a pessary that can flip inside the vagina suggests a larger size is needed.
• Your symptoms come back, such as the bulge, pressure or leaking, even with the pessary in.

If your pessary keeps coming out, our guide on what to do when a pessary falls out covers the common causes. Size is only one of them. Straining on the toilet, a wide vaginal opening, or the wrong style for your type of prolapse can play a part too. O&G Magazine points out that when a pessary is pushed out with straining, it may be too small, or you may need a different type.

Too big or too small? A quick symptom table

Use this to guide a talk with your clinician, not to diagnose yourself.

What you notice	What it can mean	What to do
Pressure, ache or cramping that does not ease after a day or two	Too big, or sitting in the wrong spot	Remove it if you have been taught how, and call your clinician
Hard to start peeing, a weak stream, or trouble having a bowel movement	Too big or pressing on the urethra or rectum	Call your clinician promptly. If you cannot pee at all, get same-day care
Soreness, spotting or new bleeding	Rubbing or pressure on the vaginal wall (or another cause)	Stop wearing it and see your clinician before you switch sizes
It slides down or falls out when you cough, strain or have a bowel movement	Too small, or a different type may be needed	Note when it happens and ask about the next size up
You can feel it twist, turn sideways or move around	Often too small	Ask your clinician to recheck the fit
Your bulge or leaking comes back with the pessary in	Too small, or not the right style	Ask whether a larger size or a ring with support makes sense

When to stop and call your clinician

Do not try to fix these with a size change at home. Call your doctor or nurse if:

• You cannot pee or have a bowel movement with the pessary in.
• You have pain with the pessary in, or when you pee or have a bowel movement.
• You have bleeding that is not your normal period.
• You notice discharge with a bad smell.
• You cannot remove the pessary yourself.

Most of these come from Michigan Medicine's pessary handout. HealthLinkBC also lists open sores in the vaginal wall as a possible problem, and notes that a correct fit helps keep problems to a minimum.

Changing size is common, and not a failure

If your first pessary does not fit perfectly, that is expected. The AFP review describes pessary fitting as "trial and error" and says that having to change the size at least once after the first fitting is not uncommon. It also recommends a follow-up visit within a week or two to recheck the fit.

Your body can also change over time. If a size that used to fit starts slipping or pressing, ask for a recheck. See our guide to refitting after menopause or weight change.

How to pick the next size

Once you and your clinician agree that the size is off, here is a simple way to move forward.

1. Keep the same style

If a ring with support was working apart from the size, stay with a ring with support. Change one thing at a time so you know what made the difference.

2. Move one size at a time

SciMed ring sizes are numbered in order: 0–8 with support and 0–9 without support. Sizes 3–5 are the most common. If your size 4 slips out, the usual next step is a size 5. If a size 4 presses, the next step is a size 3. Skipping sizes makes it harder to find the best fit. Our ring pessary size guide explains how sizes compare.

3. Consider having two or three neighboring sizes on hand

If you and your clinician think you are right between two sizes, it can help to try both. SciMed offers two ways to do this:

• 2-size combo pack ($89.99): two neighboring sizes, such as 3 and 4 or 4 and 5.
• 3-size fitting pack ($129.99): three sizes in a row, such as 3, 4 and 5, with or without support.

Not sure which pack fits your situation? Our comparison of combo pack vs 3-size fitting pack vs a single ring lays out the choices.

4. Write it down

Once you find the size that works, ask your clinician to note the type and size in your chart, and keep a note at home. This is especially helpful for daughters and caregivers who order for a parent, because it makes reordering simple and avoids guessing later. Bring your questions to your next pessary check-up.

Frequently asked questions

How should a ring pessary feel when it fits right?

A well-fitted ring pessary usually cannot be felt when you sit, walk, bend or use the toilet. It stays in place when you cough or strain, and you can pass urine and stool normally. If you are always aware of it, feel pressure or pain, or it keeps slipping, ask your clinician to check the fit.

Can a pessary that is too big make it hard to pee?

Yes. Trouble passing urine or stool can mean the pessary is pressing too hard. A family medicine review advises that if a woman cannot pass urine with the pessary in place, it should be removed and the next smaller size fitted. If you cannot pee, remove the pessary if you have been taught how, and contact your clinician the same day.

Is it normal to need a different pessary size after the first fitting?

Yes. Fitting is done by trial and error, and changing size at least once after the first fitting is common. Your body can also change over time, so a size that fit well before may need a recheck later.

Should I go up or down more than one size at a time?

In most cases, a change of one size is the next step, and your clinician should guide it. Ring pessary sizes are numbered in order, so the next size up or down is one number away. Jumping two or more sizes without an exam is not a good idea.

Do I need a new prescription to order a different size?

SciMed ring pessaries do not need a prescription. Even so, it is best to have your clinician confirm the new size, especially if they did your first fitting. Ask them to write the type and size in your notes so reordering is simple.

Written by the SciMed Clinical Team. This article is for general education and is not medical advice. Please talk with your doctor or pelvic health clinician about your own situation.