Can a Pessary Really Cause Constipation?

Constipation is a recognized side effect of pessary use, but the relationship between pessaries and bowel trouble is more complicated than a simple cause-and-effect. Constipation appears on the list of common pessary complaints alongside vaginal discharge and discomfort, yet research consistently shows that for many women with pelvic organ prolapse, wearing a properly fitted pessary actually improves bowel function over time. The explanation for this apparent contradiction lies in the anatomy of the pelvis and the condition the pessary is treating in the first place.

Why Constipation Appears on the Side-Effect List

The vagina and rectum share a thin wall of tissue, and a pessary sits right against it. A device that is slightly too large, positioned a bit off, or made of a rigid material can press into the rectal space and narrow the passage stool needs to travel through. That mechanical pressure is enough to slow things down or make evacuation feel incomplete. A review in the International Urogynecology Journal noted that the most common side effects of pessary use include vaginal discharge, odor, bleeding, pain, and constipation, with roughly half of pessary users reporting at least one of these issues.¹

That statistic deserves some context, though. The figure lumps all side effects together. A woman who notices some extra discharge and a woman who develops significant constipation both count the same way. And the review does not break down how many of those women had constipation specifically versus one of the other complaints. So while constipation is real and documented, the headline number overstates how frequently it occurs as an isolated problem.

Prolapse Itself Is Often the Bigger Problem

Here is where the story gets counterintuitive. The condition that leads most women to a pessary in the first place, pelvic organ prolapse, is itself a major driver of constipation. When the pelvic floor weakens and organs shift downward, the rectum can bulge into the vaginal wall, creating a pocket called a rectocele. Stool gets trapped in that pocket instead of moving straight through, leading to straining, incomplete evacuation, and the classic feeling that something is blocking the way out.

A study published in Scientific Reports examined women with pelvic organ prolapse and found that obstructed defecation affected about 43% of them, while true rectocele was present in roughly 23%. The two were related: the structural bulge contributed directly to difficulty passing stool.² In other words, many women already have significant bowel trouble before they ever see a pessary. When constipation persists or shows up around the time a pessary is placed, it is easy to blame the device when the underlying prolapse may be the real culprit.

When a Pessary Actually Helps Bowel Function

This is the part that surprises most people. A well-fitted pessary lifts prolapsed tissue back into a more normal position, and that repositioning can take pressure off the rectum and restore a more functional pathway for stool. The result, for many women, is that bowel symptoms get better, not worse.

A study tracking women over 12 months of pessary use found significant improvements in both bowel-related symptoms and bowel-related quality of life.³ The improvements were not marginal; they were statistically clear and persisted across the full follow-up period. The researchers concluded that pessary use in women with prolapse was associated with a decrease in bowel-related complaints overall.

This finding makes anatomical sense. If a rectocele is trapping stool and making evacuation difficult, and a pessary pushes that bulging tissue back where it belongs, the obstruction is reduced. The pessary is not just managing the prolapse symptom of vaginal bulging; it is incidentally fixing the mechanical cause of the constipation as well. For these women, the pessary is a constipation treatment, not a constipation cause.

How Pessaries Compare to Surgery for Bowel Symptoms

A reasonable follow-up question is whether surgery does a better job of resolving bowel issues than a pessary. A randomized clinical trial published in JAMA compared pessary treatment with surgical repair for symptomatic pelvic organ prolapse and measured colorectal-anal distress as one of several outcomes. Both groups showed similar improvements in bowel symptom scores, and the difference between the two approaches was not statistically significant.⁴

That is a meaningful finding for anyone weighing their options. If you are considering surgery partly because you hope it will fix your constipation better than a pessary, the evidence suggests the two approaches perform about the same on that front. Surgery has its own risks, recovery time, and potential complications, so the fact that pessaries deliver comparable bowel-symptom relief gives them a stronger case as a first-line option than many women assume.

Fit, Type, and What Goes Wrong

Not every pessary experience is positive, and the difference between a pessary that helps and one that causes trouble often comes down to fit. Pessaries come in a wide range of shapes and sizes, from ring styles that are relatively flexible to Gellhorn types with a rigid stem. A device that is too large can press excessively against the rectum. One that is the wrong shape for a particular woman’s anatomy may sit in a position that creates more rectal compression than necessary.

When constipation develops or worsens after a pessary is placed, the first question to ask is whether the fit is right. Many women go through a trial-and-error process of trying different sizes or styles before landing on one that works. A pessary that fits well should be comfortable enough that you barely notice it during daily activities, and it should not cause new pressure in the rectal area. If you feel like you are straining more than before the pessary was placed or if you sense a new obstruction during bowel movements, that is a signal to go back to your provider and try a different fit.

There is also a timing element. Some women notice mild constipation in the first few weeks of pessary use as their body adjusts to the device, and it resolves on its own. Others find that the problem persists, which is a sign the device needs to be swapped rather than tolerated. The general principle is that a pessary should make your life easier, not add a new problem to manage.

What Happens When a Pessary Is Neglected

The most serious bowel complications from pessaries are almost entirely preventable, and they happen when a device is left in place for months or years without follow-up. A forgotten or neglected pessary can erode into the vaginal wall and, because of the close proximity, into the rectum as well. The consequences can be severe.

One case report described a 66-year-old woman who had a Gellhorn pessary in place for five years without medical follow-up. She presented with constipation and a persistent vaginal bulge. On examination, the stem of the pessary had eroded through the posterior vaginal wall and into the anterior rectal wall, creating a rectovaginal fistula, an abnormal connection between the rectum and vagina.⁵ Another case documented a Gellhorn pessary that had migrated entirely into the lumen of the rectum, requiring removal under anesthesia and leaving a large fistula behind.⁶

Even more dramatically, impacted pessaries have caused mechanical bowel obstruction, a condition where the intestine is physically blocked and stool cannot pass at all. One published case specifically linked a bowel obstruction to an impacted vaginal pessary and emphasized that clinicians should keep these devices in mind when evaluating unexplained abdominal complaints in elderly women.³

These cases sound alarming, but they share a common thread: the pessary was left unattended for an extended period. Regular follow-up visits, where a provider removes the pessary, inspects the vaginal tissue, cleans the device, and reinserts it, prevent erosion from progressing to the point of fistula or obstruction. Most guidelines recommend follow-up every three to six months, though some women learn to remove and clean their pessaries at home, which gives them even more control.

Vaginal Estrogen and Pessary Tolerance

Many women who use pessaries are postmenopausal, and lower estrogen levels thin the vaginal tissue, making it more vulnerable to irritation and erosion. Vaginal estrogen cream or tablets can help maintain tissue health, and research suggests it also makes women more likely to stick with pessary use long-term.

A study found that women using vaginal estrogen alongside their pessary were significantly less likely to discontinue pessary use compared to those who did not use estrogen. They were also less likely to develop increased vaginal discharge.⁷ Interestingly, estrogen did not appear to protect against vaginal erosions or bleeding specifically, so its benefit seems to be more about overall tissue comfort and moisture than about preventing mechanical damage from the device.

The connection to constipation here is indirect but worth understanding. If low estrogen makes the vaginal tissue dry and fragile, the pessary may shift position more easily or cause discomfort that discourages proper use. A woman who removes her pessary frequently because of irritation, or avoids wearing it altogether, is not getting the prolapse support that could be helping her bowel function. Vaginal estrogen helps keep the device comfortable enough to wear consistently, which in turn helps the pessary do its job of supporting pelvic anatomy and potentially improving bowel symptoms.

Practical Steps if You Are Experiencing Constipation With a Pessary

If you are wearing a pessary and struggling with constipation, there are several things worth considering before concluding the pessary is to blame:

Check the timeline: Did the constipation start before or after the pessary was placed? Many women with prolapse had bowel issues long before treatment began, and it is easy to attribute a longstanding problem to a new device.
Reassess the fit: Ask your provider whether a smaller size or different shape might reduce rectal pressure. A ring pessary, for instance, tends to exert less posterior pressure than a Gellhorn.
Try positional adjustments: Some women find that using a small footstool to elevate their knees during bowel movements, sometimes called the squatting position, reduces straining regardless of whether a pessary is involved.
Keep up with follow-up: Regular visits let your provider catch tissue changes early and adjust the device before problems develop.
Ask about vaginal estrogen: If you are postmenopausal and not already using it, topical estrogen can improve tissue health and pessary comfort.

Dietary changes, hydration, and gentle physical activity all remain the standard first-line approaches for constipation whether or not a pessary is in the picture. A pessary does not change the basic physiology of digestion; it changes the geometry of the pelvic floor. Addressing both the mechanical and the dietary sides of constipation gives you the best chance of relief.

When Constipation Means the Pessary Is Not the Right Fit

For a small number of women, constipation genuinely worsens with pessary use, and no amount of resizing or switching styles resolves it. This sometimes happens when the prolapse involves the posterior compartment specifically, where the rectum is the primary organ shifting out of place. In these cases, a pessary that supports the vaginal walls may inadvertently compress the rectum further, creating a new obstruction even as it resolves the bulging sensation.

If you have tried multiple pessary types and still find that your bowel function is worse with the device in place, that is a legitimate reason to discuss surgical options with your provider. As the JAMA trial showed, surgery and pessary use produce similar improvements in bowel symptoms on average, but averages hide individual variation.⁴ A woman whose anatomy does not cooperate with a pessary may be among those who do better with surgical repair. The point is not that one approach is universally superior but that the right choice depends on how your body responds.

It is also worth knowing that some defecatory problems associated with prolapse do not fully resolve with either pessaries or surgery. When the pelvic floor muscles themselves are weak or the nerves controlling rectal sensation have been stretched, the mechanics of evacuation can remain impaired even after the structural prolapse is corrected. Pelvic floor physical therapy, sometimes combined with biofeedback, targets the muscular and coordination side of the problem and can be a valuable complement to either pessary use or surgical repair.

Self-Managed Pessary Care

A growing trend in pessary management is teaching women to handle their devices at home rather than requiring clinic visits every time the pessary needs cleaning. Self-management means removing the pessary at regular intervals, washing it, and reinserting it. Women who manage their own pessaries tend to catch problems earlier, because they are inspecting themselves regularly and can feel when something has changed. They are also able to remove the pessary temporarily if they feel rectal pressure building, something that can be useful around the time of a bowel movement.

Not every woman is a candidate for self-management. It requires enough dexterity and comfort with one’s own anatomy to handle insertion and removal, and some pessary shapes are easier to manage independently than others. Ring pessaries with a notch or fold tend to be the most user-friendly for self-care, while Gellhorn pessaries with their suction-cup design can be trickier. If constipation is a recurring issue for you, being able to briefly remove the pessary before attempting a bowel movement and then reinserting it afterward is a practical workaround that avoids the all-or-nothing choice between wearing the device and living with bowel difficulty.

Your provider can walk you through the technique and help you decide whether self-management makes sense given your specific pessary type and comfort level. For many women, this added control transforms the pessary from something that feels like it is happening to them into a tool they actively use on their own terms.