April 22 2025

Why We Need to Talk About Pessaries Sooner: What New Research Says About Postpartum Support for Pelvic Floor Problems

You’re not “broken” after birth. But you might need more support than Kegels and crossed fingers.

“I thought the pressure was just from carrying my baby. I didn’t know I was dealing with prolapse.”

If that hits close to home, you’re not alone. I’ve been the mom in the thick of early postpartum — new expectations, big feelings, and a body that just doesn’t feel like mine anymore. I’ve also been the pelvic floor PT on the other side of the table, listening to patient after patient tell me they were told to “just give it time.”

Here’s what we don’t say loudly enough: You don’t have to wait. And you’re allowed to want to feel supported now.

That’s where postpartum pessaries come in. And the research is finally catching up to what a lot of us have suspected for years — that we may be holding this tool back until things get bad, when we could be offering it a whole lot sooner.

What even is a pessary?

A pessary is a soft, flexible device worn inside the vagina to support pelvic organs like the bladder, uterus, or rectum. Think of it like a sports bra or an orthotic — but for your pelvic floor. It’s not surgery. It’s not medication. It’s just external support that helps hold things in place while stretched, strained tissues recover.

There are different types. Some rest on the levator muscles and gently lift. Some fill vaginal space so internal structures have something to lean on. Some press right under the urethra to cut down on leaking with coughing, laughing, or running. Many stay put with a bit of suction during the day.

And here’s the thing: pessaries aren’t new. We’ve had versions of them for a long time. They’ve just traditionally been reserved for people with severe symptoms — the ones who’d “failed” pelvic floor PT, didn’t want surgery, or were stuck waiting months for a specialist. As a PT, I didn’t used to reach for them early either, partly because the road to getting one was exhausting: the wait for a urogyn or OB, then the wait for a fitting, then follow-ups for adjustments. Plus the quiet, awful belief a lot of moms carry that needing one means your body is “broken.”

It isn’t. And the access piece is finally shifting — more pelvic PTs in the U.S. are training to fit pessaries, following the lead of our international colleagues. The barrier is starting to drop.

So what does the research actually say?

Let me walk you through it, strongest evidence first.

The headline: a randomized trial put pessaries head-to-head with PT — and they came out on top for satisfaction

In 2024, Lange and colleagues ran the first randomized controlled trial comparing three real-world options for postpartum urinary incontinence: a vaginal cube pessary, pelvic floor muscle training (PT), and “standard care” (a midwife- or PT-led group exercise course). Fifty-two women with postpartum leaking were randomized into the three groups and followed for 12 weeks.

The outcome they measured was simple and refreshingly patient-centered: Did the treatment reduce your symptoms to your satisfaction?

The results:

Vaginal pessary: 77.8% satisfied
Standard care: 41.2% satisfied
Pelvic floor muscle training: 23.5% satisfied

That difference was statistically significant, and — importantly — no complications were reported in any group.

Now, I’m a PT. Reading “PT came in last” stings a little. But here’s the honest read: this was a small, first-of-its-kind study, only 12 weeks long, measuring self-reported satisfaction. It doesn’t say PT doesn’t work. What it does say is that for fresh postpartum leaking, a pessary gave more women relief they were happy with, faster — and the authors themselves point to combining approaches as the obvious next question. We may not have to choose. A pessary can buy comfort and confidence while we build strength. That’s not pessary versus PT. That’s pessary and PT.

The supporting evidence: women will actually use these early — and feel better

A German research group ran a large prospective study (Kiefner et al., 2023) handing the Restifem pessary to 857 women and asking them to start at 6 weeks postpartum. It wasn’t designed to prove the pessary works — it was designed to answer a more basic question: Will women actually use one this early, and can they manage it?

Of the women who responded and used it, the early symptom reports were genuinely encouraging. At three months, among women with symptoms:

94% with prolapse reported improvement
72% with urinary incontinence reported improvement
66% with overactive bladder reported improvement

And 88% of women with no symptoms at all said they felt more stable. Handling it wasn’t a dealbreaker either — about 60% found insertion easy and 83% found removal easy after a couple of weeks. Serious complications were rare.

The honest caveat: there was a big drop-off in who kept responding, the symptom questionnaire wasn’t a validated tool, and the pessary was handed out two days after birth with no in-person fitting — which probably hurt follow-through. So: promising and very usable, but feasibility, not proof.

And over a full year: a real signal, with a real asterisk

The same group followed that cohort out to 12 months (Beer et al., 2024), comparing women who chose to use the pessary against those who didn’t, using a validated German pelvic floor questionnaire at 6 weeks, 6 months, and 12 months.

The pessary users improved more — significantly so in their bladder scores and prolapse scores from 6 weeks to a year out.

Here’s the asterisk, and it matters: this wasn’t randomized. Women picked their own group, and the pessary users started out worse — more symptoms, more distress. So they had more room to improve. The authors are refreshingly upfront that they can’t say whether the bigger improvement came from the pessary itself or simply from having further to recover (tissues heal a lot in that first year regardless). So: a real, encouraging signal — not a slam dunk. File it under “promising, needs a proper randomized trial.”

What I take from all of this

Put it together and the picture is honest and hopeful:

The randomized trial is the strongest piece, and it favors pessaries for postpartum leaking satisfaction.
The cohort work shows women can and will use them early, and most feel better doing it.
None of it proves a pessary “fixes” prolapse or replaces rehab — and the long-term function data still has a question mark over it.

The open questions are the interesting ones: What’s the ideal timing? And is pessary + PT better than either alone? My clinical money is on “yes,” but I’ll wait for the data to catch up.

Who might consider one?

You may be a candidate if:

You’re 6+ weeks postpartum (yes, even after a C-section)
You feel pelvic heaviness, bulging, or leak when you move
You want to get back to impact — running, lifting, hiking, or just chasing your kid — with less fear
You want non-surgical, non-invasive support sooner rather than later

There’s also an emerging idea that women who see prolapse but don’t feel symptoms might benefit preventively. I want to be clear: that’s a hypothesis the researchers are calling for trials on — not settled science. But it’s a conversation worth having instead of just waiting for things to get worse.

What’s still getting in the way?

Despite the data, pessaries are wildly underused postpartum. Why?

Not enough providers are trained or confident in fitting them
The “they’re only for older women” myth won’t die
Moms feel unsure or intimidated about using one
They get offered too late — once symptoms are already severe

Let’s make a pessary conversation as routine as the perineal ice packs and nipple cream we hand out without a second thought.

If you’re a provider:

Start the conversation early — ideally before or at the 6-week visit, so moms can make an informed choice once tissues have healed and bleeding has settled.
Mind the tissue. Support good local healing, and consider topical vaginal estrogen for lactating moms dealing with dryness or irritation from low local estrogen.
Pair it with PT for strength, pressure management, and a real return to function.
Normalize it — same tone you’d use for a knee brace or an orthotic.
Follow up. Don’t fit and forget. More PTs fitting early means better troubleshooting.

If you’re a mom:

Ask about your options. If you don’t ask, the answer is always no. Feeling pressure or leaking? Ask whether your provider fits pessaries or can refer you.
You’re not alone. Roughly 1 in 3 women deal with leaking in the first few months postpartum. You don’t have to white-knuckle through it in silence.
You can try it out. This isn’t a forever commitment. It’s about finding what works for you.

Let’s stop telling moms to wait until things get bad before they get help.

You deserve to feel strong, supported, and confident now — not after some vague stretch of “give it time.” The research is genuinely promising: early pessary use looks safe, well-tolerated, and seriously underused.

So if you’re a mom navigating symptoms, or a clinician holding off on offering a simple tool, ask yourself:

What would healing look like if we stopped waiting for dysfunction to show up before we offered support?

A quick access note for 2026: some over-the-counter and online supports exist (Uresta is a reusable one still on the market), but heads-up — Poise Impressa was discontinued, so if you’ve seen it recommended in older posts, it’s no longer available. The most reliable path is still a proper fitting with a provider who can match the device to your body.

I also completed a podcast Support Device Mini-Series including 6 internal and 4 external support device products on the Active Mom Podcast. Here’s the YouTube Links but you can find the episodes on wherever you listen to podcasts:

#PostpartumProlapse #PelvicFloorSupport #PessaryPower #ActiveMomRecovery #ReturnToRun #PostpartumHealing #PelvicPT #UrinaryIncontinence #StrongNotSilent #ActiveMomPostpartum

References

Lange S, Lange R, Tabibi E, Hitschold T, Müller VI, Naumann G. Comparison of Vaginal Pessaries to Standard Care or Pelvic Floor Muscle Training for Treating Postpartum Urinary Incontinence: a Pragmatic Randomized Controlled Trial. Geburtshilfe Frauenheilkd. 2024 Mar 6;84(3):246-255. doi:10.1055/a-2243-3784. PMID: 38455997; PMCID: PMC10917606.

Kiefner B, Schwab F, Kuppinger M, Nacke A, Kelkenberg U, Schütze S, Berger F, Lindner A, Hellmeyer L, Janni W, Metz M, Deniz M. Evaluating compliance and applicability of postpartum pessary use for preventing and treating pelvic floor dysfunction: a prospective multicenter study. Arch Gynecol Obstet. 2023 Aug;308(2):651-659. doi:10.1007/s00404-023-07075-9. PMID: 37210701; PMCID: PMC10293351.

Beer F, Kuppinger M, Schwab F, Hübner M, Kiefner B, Nacke A, Kelkenberg U, Schütze S, Lindner A, Hellmeyer L, Janni W, Metz M, Deniz M. Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study. Arch Gynecol Obstet. 2024 Oct 10;311(4):1209-1217. doi:10.1007/s00404-024-07758-x. PMID: 39390126; PMCID: PMC11985659.