There are several choices of inserted vaginal devices to help manage stress urinary incontinence caused by weakened pelvic floor muscles. They can help stop or significantly reduce leaks. These devices typically press against the wall of the vagina and support the urethra. This leads to fewer leaks with minimal risk. Some devices claim to be able to completely stop leaking, while others claim to significantly reduce leaking. The truth depends on your condition and body type, the results will vary from person to person. There are different types of devices women can use which include:
A traditional vaginal pessary is a firm yet flexible device that is inserted into the vagina and left inserted 24 hours a day for up to 3 months. It repositions and supports the urethra and/or uterus. There are several styles, makes, and brands that all claim to help manage stress urinary incontinence to one degree or another. None of these however eliminate SUI, in other words they do not fix stress urinary incontinence, they simply help stop or reduce leaking while the pessary is in use. Traditional vaginal pessaries have been around for centuries and most cannot be self-managed on a daily basis. Generally, these require the assistance of a healthcare professional, and the patient needs to have a physical exam 3-4 times a year to check for vaginal abrasions and to have the device cleaned and repositioned. These types of pessaries, while effective, can often rotate or fall out of position during daily activities rendering them ineffective and requiring the patient to schedule a visit with their healthcare provider to have it removed and re-inserted. The pessary must be removed before having sexual intercourse as it obstructs the vagina. This does not make this style of pessary ideal for active lifestyles. There are some newer versions available that are more patient friendly and can be self-managed, so they don’t require the assistance of a healthcare professional.
A single use, disposable pessary is available over-the-counter without a prescription. Similar to a tampon, you insert the device with an applicator. Once the pessary is in the vagina, the core and cover of the device support the urethra. These devices are made to be used for a maximum of 8 hours in a 24-hour period. You remove it from the vagina using a pull string. It is thrown away after use. All disposable pessaries have some risk of irritation or infection. If you notice this, let your healthcare provider know immediately.
Some women find that inserting a simple tampon during exercise prevents leaks. But tampons have not been approved for this purpose. There is no research that shows tampons can prevent urinary leakage.
Re-useable Self-Managed Pessaries
Traditional pessaries are small, often made of medical grade silicone or similar materials. Most must be fitted for you by a specialist. There are some newer prescription pessaries on the market that are re-useable, self-fitted and self-managed. These can still be fitted by a healthcare professional if preferred by the patient; however, a physical fitting is not required which means that these devices can also be prescribed via telehealth consultations in the comfort of your own home.
Re-usable self-managed pessaries often come in multiple sizes, allowing the patient to determine which size is right for them. In other words, the pessary is the right size if the fit is comfortable, unnoticeable after insertion and is effective at stopping or reducing leaks.
Like traditional pessaries, re-useable self-managed pessaries are inserted into the vagina to support the urethra through the vaginal wall and stop unwanted urine leakage. With some of the newer versions, their unique design helps them to stay in place and use is not dependent on strong pelvic floor muscles. When fitted properly, the device should be unnoticeable and the patient can go about her daily activities comfortably.
Many patients find that they only want to use these self-managed pessaries for specific activities such as running or exercising. And, that is fine. They can be inserted as needed and removed after the leak-inducing activity is finished. These next-gen devices, while they require more management by the patient, are a better solution for those with active lifestyles. They stop leaks and allow you to pursue your preferred physical activities when it suits you. No waiting for appointments with healthcare professionals; live life on your terms.
To help prevent stress urinary incontinence during high activity, you may have the option of an occlusive device (also called urethral plug). These types of devices block the urethra, compared to vaginal devices which simply support the urethra through the vaginal wall. Some urethral plugs may be shaped like a thin flexible rod. Some have a balloon on the end that can be inflated and deflated to block leaks. When it’s time to urinate, they can be deflated or pulled out entirely. These plugs are used in rare and specific cases. Currently, there are no approved urethral plugs available in the U.S.