Internal Vaginal Devices

What are internal vaginal devices?

Internal vaginal devices are also referred to as ‘intravaginal devices’. They are devices that are placed inside the vagina to support the bladder neck or compress the urethra and thereby reduce or prevent stress urinary incontinence (SUI).

They can be divided into two main categories:

Traditional devices

These are products that are not designed primarily to prevent or reduce bladder leakage, but that may help to do so. For example, tampons (for menstruation), pessaries (usually for prolapse) and contraceptive diaphragms. Tampons are a relatively cheap, easy and acceptable product that can be effective at reducing leakage. Reference: Nygaard 1995 Pessaries and diaphrams have also been found to reduce leakage. Reference: Suarez 1991, Realini 1990, Bhatia 1985

Purpose-made devices

These are products designed specifically to reduce SUI. Although many products have appeared on the market, few have stood the test of time. Most products have been simple surgical foam tampon-shaped cylinders with withdrawal strings intended to support the bladder neck in much the same way as a traditional tampon. References: Cameron 2010, Thyssen 1996, Thyssen 1999, Morris 2003, Allen 2008, Glavind 1997.

A newer product is referred to as an ‘intravaginal bladder support’ by manufacturers. This device is inserted into the vagina by the user herself using an applicator much like a normal tampon applicator. The device features soft nylon mesh stretched over a shaped silicone core, which expands after the applicator is withdrawn to provide support to the urethra in order to prevent incontinence. This is a single-use, disposable over-the-counter product available in a range of sizes. References: Ziv 2009, Farage 2011 Other products include re-usable bladder neck support prostheses, called intravaginal rings, which are inserted and removed by the user each day. References: Biswas 1988, Davila 1999, Kondo 1997

Who are internal vaginal devices good for?

These devices are most suitable for women with stress urinary incontinence (SUI), who have good hand function, and who are happy with the idea of inserting them. While the devices work well for some women, for others they do not.

They may be most effective for women with minimal to moderate SUI leakage. Intravaginal rings have been found to be less effective in women with mixed urinary incontinence. Reference: Moore 1999

Pessaries can be used to manage pelvic organ prolapse (POP), which is often accompanied by SUI. While for some women with POP the use of a pessary to support the prolapse can help to reduce SUI, others report newly occurring SUI when they use a pessary. Reference: Ding 2016, Lone 2015, Manchana 2012

Internal urethral devices can be used by women with both bowel and bladder leakage, but they will not improve the bowel leakage. You can read more about products for bowel leakage here.

When do internal vaginal devices work best?

Internal vaginal devices are intended for use during normal everyday activities. They may also be useful for some women to provide occasional continence protection during physical activities such as exercising or dancing.

However, any internal device can cause discomfort or irritation so that it may be best to limit their use to daytime - when SUI is most likely to occur - or to certain activities when wearing a pad may be less convenient.

Disposable devices are intended to be used only for up to twelve hours in any twenty-four hour period.

What about fitting?

If you have good use of your hands and are used to inserting tampons or diaphragms then you will probably have no difficulty using the devices.

Many women in many countries are familiar with using traditional tampons. They are generally easy to insert and are available in different sizes (for light to heavy flow).

Contraceptive diaphragms and pessaries may need to be sized and fitted, at least in the first instance, by a trained healthcare professional.

Disposable bladder supports are designed to be inserted into the vagina by the user herself using an applicator much like a normal tampon applicator, which is then withdrawn. The devices are available in three sizes, and a starter kit is available for women to find out which size is most effective for them.

Some women find fitting devices difficult, especially those with altered vaginal anatomy after childbirth or multiple surgeries. Reference: Moore 1999 If you are unsure about your ability to fit this kind of device, trying a tampon first will give you an indication as to whether or not you would be able to use other devices.

If you are thinking of trying an intra vaginal device it may be useful to discuss it with your healthcare professional.

What other products could ‘mix and match’ well with internal vaginal devices?

It may be best to limit the use of any internal vaginal devices to specific times or to certain activities, especially if you experience discomfort or other problems. Some devices are intended only for time-limited use: for example, disposable bladder supports are intended to be used only for up to twelve hours in any twenty-four hour period.

Some women find that while the devices reduce their incontinence, they do not prevent leakage completely, so that they still must wear a pad, but a smaller one than they would without the device.

For these reasons, in addition to the devices, many women will need to use other products to manage their incontinence, such as absorbent pads or pants.

Might vaginal devices cause any problems?

Standard tampons: Many women in many countries are very familiar with wearing tampons during menstruation. There is much heated discussion (especially on the internet) about how often they must be changed, whether they can be worn overnight, and so on. However, the general consensus is that as long as they are changed at least every 12 hours or more often they are safe.

Some women who have used intravaginal rings have found that they can cause discomfort or irritation and, less commonly, urinary tract infection. Reference: Davila 1999

Some women have found that diaphragms can cause discomfort and long-term use of pessaries can be associated with bleeding, extrusion (the device is pushed out), discharge and pain. Reference: Suarez 1991, Cameron 2010

Some women who have tried disposable bladder supports have experienced discomfort, pain and spotting with blood. Reference: Ziv 2009, Farage 2011

Although the devices may cause some discomfort, some women find this an acceptable trade off for a reduction in leakage. Reference: Hahn 1996

If you do try an internal vaginal device, it is recommended that you see your health care professional every 6-12 months to have its use reviewed. Reference: Gorti 2009

Internal urethral valve/pump

What is an intraurethral valve/pump device?

These are short silicone tubes that remain in place in the urethra day and night, with one end inside the bladder and the other outside the body. Inside the bladder, soft silicone petals prevent the device from being expelled, and at the outer end a soft flange prevents it from moving further into the urethra. The outside end of the device is just at the entrance to the urethra, so that it is in effect invisible without close inspection.

When in place, the device prevents urine from leaving the bladder. However, inside the silicone tube there is a tiny magnetic pump and the woman can use a rechargeable handheld remote control unit to switch this pump on to empty the bladder when desired, mimicking normal urination.

Who are intraurethral valve/pump devices good for?

These devices are currently intended only for women who have chronic urinary retention (cannot empty the bladder normally) due to impaired bladder muscle function, and who would normally have to rely upon intermittent or indwelling catheterisation.

To be able to use such a device for bladder control, women must have good enough hand control to operate the handheld unit, and must be able to remember to empty the bladder at regular intervals.

These devices are not suitable for women with poor hand control, poor memory or memory problems.

Evidence from studies that have tested the devices suggest that while they work well for some women, for others they do not, and a trial period may be useful in determining whether women are likely to benefit. The main reason for women to stop using the device was discomfort. However, for women who tolerated the device well there was a high level of satisfaction, improved quality of life, and few complications. References: Chen 2005, Mazouni 2004, Lynch 2003

When do intraurethral valve/pump devices work best?

Intraurethral valve/pump devices are intended for long-term use during all normal activities.

What about fitting?

These devices must be inserted by a health care professional, and are replaced monthly. However, in the event of severe discomfort or device malfunction, they can be removed easily by anyone – including the woman - by gently pulling it out of the urethra.

Before first fitting the device, the health professional must use a special sizing device to determine which size is most suitable. To insert the valve/pump device, the health professional will use a special applicator and a local anaesthetic gel. Mild painkillers may be prescribed for the first week or two of use while the woman becomes accustomed to how it feels.

What other products could ‘mix and match’ well with intraurethral valve/pump devices?

The device is intended to provide complete management of bladder emptying, so that in principle no other products are necessary (other than the handheld remote control and charger). However, in studies that tested the devices, some women found that they experienced some degree of urinary incontinence even with the device in place. An absorbent product may be required at least as a precaution by some women. References: Chen 2005, Mazouni 2004

Might intraurethral valve/pump devices cause any problems?

Potential problems associated with intraurethral valve/pump devices are similar to those associated with normal indwelling or intermittent catheterisation and include discomfort, bladder spasms, urgency and frequency, haematuria, urinary tract infection and device malfunction (expulsion, blockage). References: Chen 2005, Mazouni 2004, Lynch 2003