Internal Vaginal Devices

What are internal vaginal devices?

Internal vaginal devices are placed inside the vagina to support the bladder neck or compress the urethra and thereby reduce or prevent leakage.

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 they may help to do so. For example:

• tampons (for menstruation)
• pessaries (usually for prolapse)
• contraceptive diaphragms.

Tampons are a relatively cheap, easy and acceptable product that can be effective at reducing leakage¹. Pessaries and diaphrams have also been found to reduce leakage²³.

Purpose-made devices

These are products designed specifically to reduce SUI. For example:

• A simple surgical foam tampon-shaped cylinder with withdrawal strings intended to support the bladder neck in much the same way as a traditional tampon⁴⁵⁶⁷⁸⁹.
• Intravaginal bladder support - 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 The device features soft nylon mesh stretched over a shaped silicone core, which expands after the applicator is withdrawn to provide support to the urethra in order to prevent incontinence.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 sizes¹⁰¹¹.
• Intravaginal ring – these are re-usable bladder neck support prostheses which are inserted and removed by the user each day¹²¹³.

Who are internal vaginal devices good for?

These devices are most suitable for women with stress urinary incontinence (SUI), who have good hand function, healthy urethral and vaginal tissue, 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 incontinence¹⁴.

Pessaries can also 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 pessary¹⁵¹⁶¹⁷.

Internal vaginal 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 that work well if you have bowel leakage.

When do internal vaginal devices work best?

Internal vaginal devices are intended for use during normal everyday activities. The intravaginal bladder support is intended to be used only for up to twelve hours in any twenty-four-hour period.

However, any internal device can cause discomfort or irritation so that it may be best to limit their use to times when wearing a pad may be less convenient.

They may be most suitable for use intermittently to provide occasional continence protection during physical activities such as exercising or dancing¹⁸.

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 are familiar with using traditional tampons. They are generally easy to insert and are available in different sizes.

The intravaginal bladder support is designed to be inserted into the vagina by the user herself using an applicator much like a normal tampon applicator, which is then withdrawn. It is available in different sizes with a starter kit 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 surgeries¹⁴. 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. Otherwise, ask you healthcare professional for help with fitting.

Pessaries should be sized and fitted by a trained healthcare professional. Once the device has been fitted correctly it may be possible for you to manage it yourself.

One consideration when selecting a device is the length of time it is intended to last. Some silicone pessaries last for up to 6 years but other devices have a more limited shelf life.

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

Some women find that while the devices reduce their incontinence, they do not prevent leakage completely. You may find you still need a pad but that a smaller one or washable pants would work.

Might vaginal devices cause any problems?

• Tampons: There is much discussion (especially on the internet) about how often they must be changed and whether they can be worn overnight. However, the consensus is that if they are changed at least every 12 hours or more often they are safe.

• Diaphragms can cause discomfort and long-term use of pessaries can be associated with bleeding, extrusion (the device is pushed out), discharge and pain⁴¹⁹.

• The intravaginal bladder support can cause discomfort, pain and spotting with blood¹⁰¹¹.

• Intravaginal rings can cause discomfort or irritation and, less commonly, urinary tract infection INVALID REFERENCE INDEX : 20 .

Although these devices may cause some discomfort, some women find this an acceptable trade-off for a reduction in leakage INVALID REFERENCE INDEX : 21 .

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 INVALID REFERENCE INDEX : 22 .