Incontinence

[an error occurred while processing this directive] Management of Stress Incontinence

Internal devices
The FemSoft® insert is a disposable, single-use device for the treatment of female stress urinary incontinence. It consists of a narrow silicone tube enclosed in a soft, thin, mineral oil-filled sleeve that forms a balloon at the tip. At the opposite end, the sterile tube and sleeve form an external retainer. FemSoft® is inserted into the urethra with a disposable plastic applicator. As the device is inserted, the mineral oil in the balloon drains into the external retainer. Once the tip of the device is advanced to the bladder, the oil flows back into the balloon, creating a seal at the neck of the bladder that prevents urine leakage. FemSoft® is removed and discarded when the patient wants to urinate and afterward, a new device is inserted. UTI, bacteriuria, urgency, frequency, and nocturia are potential complications.

Vaginal pessaries are silicone or latex devices inserted into the vagina to compress the urethra and support the bladder neck to prevent leakage during strenuous activity. Pessaries are available in different shapes and sizes. The incontinence ring and incontinence dish shapes are commonly used to treat stress incontinence. Women who experience leakage only during exercise may find that the cube pessary inserted before activity is all that is needed.

A pelvic examination is performed first to make sure there is no infection. An infection must be treated before a pessary can be used. Pessaries usually are fitted and inserted by a gynecologist and the largest size that can be worn comfortably is usually the most effective. Once in place, the patient is asked to cough to test for leakage.

Frequent follow-up care is required to check for infection, pressure sores, and allergic reaction. If the patient is sensitive to latex or silicone, she cannot use these devices. Pressure sores are more common in postmenopausal women. Estrogen cream can improve the integrity of the vaginal mucosa. Tissue damage is managed by removing the pessary until the skin heals. Infections are treated with antibiotics. At each examination, the pessary is removed and cleaned with soap and water. Diligent follow-up is essential for eldery or debilitated patients.

Introl® is a vaginal prosthesis with two prongs that support the bladder neck on either side of the urethra. It is used for stress and mixed incontinence. The device should not be worn continuously for more than 24 hours without proper cleaning and must be removed to have intercourse.

External devices
The Miniguard Patch® and Impress® are single-use foam pads that are slightly larger than a postage stamp. One side of the patch is covered with adhesive to hold it over the urethral opening and surrounding area. It fits between the labial folds and provides pressure around the urethral opening to prevent leakage. The wearer simply removes the patch to urinate and puts on a new patch after urination.

Small, round silicone "caps" (e.g., FemAssist®, Bard Cap Sure® Continence Shields) use suction to support the urethral sphincter (muscle that opens and closes the urethra). An ointment is applied to the inner surface to create a vacuum seal that holds the cap in place. To urinate, the wearer removes the cap, which can be washed with soap and water and reapplied. Some women experience discomfort or irritation with these devices.

External devices for men include penile clamps (e.g., Cunningham clamp) and compression rings. The penile clamp is a V-shaped casing with a foam cushion that fits over the penis. When closed, the clamp stops the flow of urine. Compression rings fit around the penis and are inflated to pinch off urine flow.

Clamps and rings must be removed every 2 to 3 hours to empty the bladder. Only patients who can adjust them properly and adhere to the voiding schedule should use them. Improper use of these devices can cause penile and urethral tissue damage, penile edema (swelling), pain, and obstruction.

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