My Pessary Fell Out or Won't Stay In: 7 Reasons + Fixes

A pessary that falls out is almost always a sizing or fit problem — not a sign that pessaries don't work for you. In 30 seconds, you can usually identify which of the 7 causes below applies and exactly what to do next. This guide is written for the woman standing in the bathroom right now wondering if she should call her doctor or just go up a size.

Quick reassurance first: a pessary falling out is not a medical emergency. There is no risk of injury, no urgent symptom. Pick it up, rinse it, set it aside, and read on.

How to know which of the 7 reasons applies to you

What's happening	Most likely cause	First fix to try
Falls out within hours of insertion, fit felt loose from start	1. Size too small	Size up one
Was fine for months, now slipping	2. Prolapse has worsened	Size up or change type; see provider
Falls out during straining or bowel movements	3. Constipation	Treat constipation; re-evaluate fit
Falls out during specific activities only	4. Wrong pessary type for activity level	Try ring with support
Falls out after losing weight	5. Tissue tightened, pessary now relatively loose	Refit one size up
Falls out a few weeks postpartum	6. Postpartum tissue changes	Refit at 6-12 weeks
Falls out and you can see bulging at the opening	7. Pelvic floor too weak for a ring; need different shape	Switch to Gellhorn or Cube; see urogynecologist

Reason 1: The pessary is too small

The single most common reason. A ring pessary holds itself in place by springing open against the side walls of the vagina, behind the pubic bone in front and in the posterior fornix in back. If the ring's diameter is even a few millimeters smaller than your vagina's resting width, gravity and abdominal pressure eventually win.

The test: stand up with a full bladder. Cough firmly 3–5 times. If the pessary descends visibly or comes out, it is too small. Go up one size (e.g., from size 3 to size 4).

The cheapest way to find the right size if you've already missed once: the 3-size fitting pack at $119.99 ships you three adjacent sizes. Try them in order, keep the one that passes the cough test, the others are yours to keep as backups.

Reason 2: Your prolapse has progressed

Pelvic organ prolapse can advance over time. A size 4 that supported you well at stage 2 may not be enough at stage 3. Signs that progression is the cause:

• You can now see or feel tissue at the vaginal opening when standing
• The heaviness or pressure you used to feel only at end-of-day is now constant
• You have new urinary or bowel symptoms
• The pessary that worked for 6+ months now slips

Fix: usually a one-size-up refit works, but if you have advanced from stage 2 to stage 3 you may need to switch from a ring without support to a ring with support or a different shape entirely. Book a urogynecologist visit if the next size up doesn't hold.

Reason 3: Constipation and straining

Hard stool and the straining that goes with it generate enormous downward pressure on the pelvic floor — often more than coughing or lifting. A pessary that sits comfortably during a normal day can be pushed out during a difficult bowel movement.

If your pessary falls out specifically on the toilet, treat the constipation first:

• Increase water to 2–3 liters daily
• Add 25–35 g of fiber (psyllium, ground flax, or food-based)
• Consider magnesium citrate 200–400 mg in the evening
• Use a Squatty Potty or similar to align the rectoanal angle
• Talk to your provider before reaching for stimulant laxatives long-term

Once stools are easy to pass, retest the pessary. If it still falls out during a comfortable bowel movement, then sizing is the issue.

Reason 4: Weak pelvic floor

A ring pessary depends on a baseline level of pelvic floor tone to stay seated. Severe pelvic floor weakness — typically after multiple vaginal deliveries, advanced age, or after pelvic surgery — means a ring may not have enough tissue to grip.

Pelvic floor physical therapy can rebuild this. ACOG Practice Bulletin No. 214 recommends combining pessary with pelvic floor muscle training for best outcomes. Most patients see measurable strength gains in 8–12 weeks of supervised PT, and the pessary often holds better as the muscles recover.

If even with PT a ring won't stay, your urogynecologist may switch you to a Gellhorn (mushroom-shaped) or Cube pessary. These hold by suction rather than spring tension and are designed for severe weakness.

Reason 5: Wrong type of pessary

If you have a cystocele (bladder prolapse) in addition to your main prolapse, a ring without support may not catch the bladder, which then pushes the entire pessary down and out. Switching to a ring with support — same size, just adds the membrane — often solves the problem instantly.

Conversely, some women on a ring with support find the membrane causes more displacement during specific positions, and the simpler without-support version works better. There is no one-right answer; it depends on which compartments are dropping.

Reason 6: Recent weight loss

This one surprises people. Significant weight loss (10+ pounds, especially around the abdomen) tightens the vaginal tissues and can change the pelvic floor angle. The pessary that fit at your previous weight may now be too small relative to the new tissue tension — or, less commonly, too large.

If you have lost meaningful weight, the cough test is your friend. Test current fit, size up or down as needed. Plan to refit any time your weight changes by 10+ pounds.

Reason 7: Postpartum changes

Postpartum, vaginal tissue is in flux for months. A pessary fit at 6 weeks postpartum may need adjustment at 12 weeks, 6 months, and again at 1 year. The trajectory is usually toward needing a smaller size as tissue tone returns.

If you are a few weeks postpartum and your pessary falls out, wait two weeks, then refit. Don't pay for a brand-new clinical fitting every two months — use the 3-size fitting pack to home-test the most likely next sizes.

When to upsize vs. change pessary type

Symptom	Try size up?	Try different type?	See provider?
Falls out within first day, no other symptoms	Yes	No	If next size also fails
Falls out after months of working fine	Try first	If size-up fails	If both fail
Falls out plus visible bulging at opening	Maybe	Likely yes (Gellhorn)	Yes — urogynecologist
Falls out plus pain or bleeding	No — stop using until evaluated	No	Yes — immediately
Falls out plus new urinary leaks	Try with-support version	Add membrane (with support)	If still leaking
Falls out only during sex	No	Consider without-support; or remove for sex	No

When to see a provider, not size up

Self-troubleshooting handles most fit problems. See a urogynecologist promptly if:

• You have new bleeding, severe pain, or unusual discharge
• You have already tried two sizes and a different type and nothing holds
• You can see tissue at or below the vaginal opening when standing
• You have a history of mesh repair
• You have not had a pelvic exam in over a year

When to switch to a Gellhorn or Cube

If your pelvic floor is too weak for a ring to hold — even at the largest size that fits — you have moved past the self-fit phase. A Gellhorn (mushroom shape) or Cube (suction shape) requires a clinical fitting because removal technique is non-obvious. These are not failure modes; they are appropriate devices for stage 3–4 prolapse.

SciMed currently focuses on ring pessaries because they cover roughly 80% of patients. For Gellhorn or Cube, see a urogynecologist who carries those styles.

Don't blame the pessary too fast

Roughly 80% of "pessaries don't work for me" reports actually trace back to one of these 7 issues, all of which are fixable. Before giving up on the pessary path, work through the troubleshooting table. A correctly-sized, correctly-typed pessary stays in place during walking, coughing, exercise, and intercourse for the vast majority of women.

Frequently asked questions

How fast should I refit if my pessary falls out?

Same day or next day. There is no reason to wait. Order the next size up online — it ships in 2–4 business days from California.

Can I just put it back in if it falls out?

Yes, after rinsing it. But if it falls out again within hours, the size is wrong and you need a different size, not the same one reinserted.

Is it dangerous if my pessary fell out and I didn't notice?

No. There is no internal organ that can prolapse acutely just because the pessary is out for a day. You may notice increased pressure or bulge, but no medical emergency.

Could a smaller pessary work better than a larger one?

Rarely. The vast majority of fit failures are too-small, not too-big. The exception is the recent-weight-loss case, where tissue tightening can occasionally call for a smaller size. The cough test resolves the question in 30 seconds.

Do I need a prescription to try the next size?

No. Ring pessaries are sold over-the-counter in the US. See no-prescription guide.

Should I take it out at night to give my tissue a rest?

It depends. Some women remove their pessary at night, some don't. Both patterns are well-tolerated long-term. If your tissue feels irritated, switching to night removal for 2–4 weeks often resolves it.

What if my pessary keeps falling out and I have no urogynecologist nearby?

Telehealth urogynecology is available in most US states. The fitting itself still needs to be in-person if you need a Gellhorn or Cube, but troubleshooting and ring sizing can be done by video.