Bladder support devices to reduce stress urinary incontinence: how do they work?

Add extra support to your bladder from the inside

Strengthening your pelvic floor is still first prize for bladder leakage problems but if you cannot create enough strength and support for the bladder with your pelvic floor muscles alone, you may benefit from one of the modern devices that tries to give some reinforcement to the bladder neck and bladder tube.

These are devices that you can buy on the internet and then insert and remove yourself.  They are designed to be worn all day but not all the time.  The most popular ones at the moment are Contrelle Activgard, Contam, Contiform and Uresta.  They vary in price chiefly relative to how many times they can be re-used.  Contiform is available on prescription.

If pelvic floor exercises, improving your core, adjusting your exercise regime and better bladder management have not been enough to resolve your bladder leakage these devices may offer an alternative to surgery, with a similar mechanism of action  (mechanical support of the urethra) to the TVT and colposuspension procedures.

How will an Internal bladder support reduce urinary leakage?

These work particularly well where you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele) but that everything else inside (particularly the uterus) is still well supported. You have created a good layer of muscles through exercise but feel you could do with a bit more support when you are trying to be more active.

These devices work by providing more support for the bladder neck.  When you move fast (jogging, playing tennis) or  there is an increase in abdominal pressure (coughing, sneezing, zumba, aerobics) the pelvic floor muscle is supposed to support the bladder neck so that there is no leakage.  However, if the muscles are weakened and/or untoned that support can be lost. 

If you are a visual person imagine a running hose pipe, lying on  soft grass.  When you lay your foot on the pipe you may slow the flow of water but you may not be able to stop it completely.  However, if that under surface is firmer, because you have laid your hosepipe on your garden path (aka a good pelvic floor, and/or a device in position) when you press down on the hosepipe the water flow stops.

hose lying on grass and path

Would it be easier to stop the water by standing on the hose on the grass or on the path?

 

What type of urinary leakage will they help?

These devices are best for small leaks associated with movement or when the bladder is under pressure from coughing, sneezing or laughing (stress urinary incontinence).

They create a mechanical uplift to support the bladder neck the way the pelvic floor is supposed to do.  What these devices can’t do is change symptoms like urgency.  If your bladder is irritated by caffeine, being too full, or you have an overactive bladder, you won’t see any improvement using one of these.  Pelvic floor exercises DO help these symptoms because the pelvic floor contracting activates neurological messages which calm the bladder down.  Unfortunately these devices can’t do that.  If these are your symptoms rather practice “endurance/holding” pelvic floor exercises (see more in the Pelvic Floor School) and have a read of the article “How much should you drink in day and when should you have a wee?” for more impact on these problems.

Can I leave it in to wee?  What about during my period?

Yes, they are all designed to be left in when you have a wee.  The pressure of the bladder squeezing is enough to push the urine past the supported area when you need to.

You could still use the Contiform pessary when you had a period (as the menstrual fluid can flow through it) but you couldn’t use a tampon at the same time.  The other designs act as a block but are not absorbant like a tampon so shouldn’t be used during your period.

Note: The term pessary can be confusing

Because these devices to reduce bladder leakage sit inside the vagina they are termed a “pessary” but they should not be confused with a  tradional pessary used for supporting Pelvic Organ Prolapse (POP).

The term pessary (plural pessaries) comes from the Latin (pessarium) and Greek (pession) which they referred to a medicated tampon made of lint to go in the vagina.  In the fascinating novel, The Red Tent, by Anita Diamant, set in Old Testament days, a midwife makes a ring pessary out of Beeswax (clever, nice antibacterial properties) and gold pessaries have been found inside female mummies in archeological digs.

There are two meanings in modern medicine:

  • a pessary as a vehicle for giving medication via the vagina (or if via the anus more often called a suppository).  You might have used a Canestan pessary for treating thrush?  Several hormone replacement medications are given this way (Vagifem and Ovestin for example) and some types of contraception
  • more commonly when we talk about someone having a pessary fitted we mean the more structured type such as a ring pessary, Gehrung, Gellhorn, shelf (Falk) or a cube.    These are designed to structurally hold the uterus right to the back of the vagina tube, or give uplift to the anterior wall of the vagina (which supports the bladder) or reinforce the posterior wall of the vagina (which acts as a boundary for the bowel).  These are also sound alternatives to surgical repair of prolapse.  These structured pessaries are usually fitted by your GP or your gynaecologist after a full examination of the prolapse problem (with lights and a speculum).  Getting a good fit is important, as is how often you have them changed.  Usually only the ring style of pessary might be the type you are able to take in and out yourself (after training).  There are some new over the counter disposable pessaries which you can buy online, such as   Contam, and Contrelle is marketed for use both as a stress incontinence device as well as a bladder wall support (depending where you position it). It is early days to see how well women finds these newer products work as more DIY options for vaginal wall support.

 

A guide to devices to reduce stress urinary incontinence

Each company markets their own product and may use more than one distributor.  Here is my personal “quick guide” to what’s out there at the moment, apologies if it has already changed again by the time you read this!  Please do let me know if I have missed something out, you find a new supplier, have comments or you would like to share your experiences with other readers?:

Contrelle Activgard   (single use only)

£14.99 starter pack of 3,  £76 for a pack of 35  available from the direct supplier  www.desmitmedical.com (with VAT exemption available *) or www.stressnomore.co.uk

I had a chat with Lyn de Smidt of desmitmedical.com (the direct supplier) today – there is a bit of a supply chain problem at the moment due to a change in the manufacturer.  Though the starter packs are out of stock she has been helping customers get started by creating these from their remaining supplies.  Do contact Lyn for help and see their website for full detailed product information (scroll down below the pictures).

Contrelle Activgard is a flexible foam plastic which you soak (to prevent drying the vagina), fold double and then insert with an applicator into the vagina (not dissimilar to a tampon, but positioned nearer to the opening) to create uplift and support for the neck of the bladder.  The foam material is suitable for the vagina pH and the product has sculpted soft edges.  Contrelle has been available for many years and Scandinavian clinical trials support its efficacy at mechanically reducing leakage without side effects.

They are disposable, single use only, but you can wear one up to 16 hours without removing it. 

Contrelle Activgard starter pack has 3 different sizes to try

You can still wee or have your bowels open as normal.    

Though these are single-use only and a more expensive option than pads, they are popular with mums who are generally not experiencing day to day stress incontinence but know when they are going to leak.  For example if they do a longer run, or go to a Zumba class.  They use them only once of twice a week. They can put one of these in before they go and not need to worry with other protection (or maybe use with a pair of Pretty Clever  Pants “just in case”).  

In this video from desmitmedical.com specialist physiotherapist Jane Appleyard explains how Contrelle Activgard can support the neck of the bladder to prevent stress urinary incontinence:

Contam pessary  (reusable for a week)

£21.99 for a normal vaginal pessary starter set from www.stressnomore.com

These are quite new on the market.  There are no clinical trials listed.

Contam is a brand offering a variety of shapes and sizes of washable resuseable (for a week) vaginal pessaries.

Contam Large Vaginal Pessary Starter Set 3

It is the tampon shaped ones that are suitable for supporting the bladder neck (and can also be used to support the uterus).

The cube shaped ones are for going much further back in the vagina to support a more severe uterus prolapse.

It is suggested that you position them differently according to the problem:

  • For incontinence: insert the pessary deep into your vagina, then pull it back slightly so that it’s within reach of your fingerscontam

Contam pessaries can be used for up to a week by washing them after each removal. The manufacturers suggest that to clean your pessary, either boil it for 3-10 minutes or place it into the washing machine at 60 degrees. Then either leave it to dry naturally or store it in a bowl of water ready for the next insertion.

 

Contiform   Pessary    (re-usable up to 30 times)

£79.99 starter pack of 3 (different sizes), or £52.99 for an individual size  from www.stressnomore.co.uk or amazon.co.uk or the distributor www.pioneermedical.com or  available on NHS prescription from your GP [starter pack: NHS order code   SKU184 , PIP code 375-5808 ]

The principle of the Contiform and its position in the vagina is the same as the Contrelle Activgard but these are re-usable up to 30 times so if you felt you needed support daily rather than ad hoc this is likely a more economical option in the longer term.

Contiform starter pack

The Contiform Pessary looks like a plastic hollow tampon.   It is a stiffer product than the Contrelle foam-feel device.  The smaller circle supports the bladder tube (the urethra), the larger surface lies against the floor of the vagina, giving support to the bowel wall.  They are made of a firm but flexible non-latex plastic and can be reused, with the guarantee  up to 30 times (there is a “slit” that develops with wear to show you when the device needs changing),  longer if not worn all day.

You can buy these online or they are now available on NHS prescription.  You would need to tell  your GP about your symptoms, and ask him to prescribe a starter pack for you.  While you are there ask for a referral to specilaist physiotherapy too if you haven’t already got your own pelvic floor coach.  If they work for you it suggests that a stronger pelvic floor could do this job naturally for you too!

This marketing video from the distributor www.pioneermedicaleurope.co.uk  looks a little dated in places but Fiona Philips clearly explains how to insert and remove it, as well as explaining precautions for use (the product demo starts at 1.51 mins):

 

 

URESTA      (lasts a year)

£179 (+VAT ) + £8 P&P  for a starter kit containing 3 sizes  from iMEDicare on 01923 237795 or via uresta.uk

VAT zero rated for user self purchase if suffering from chronic stress urinary incontinence only

Uresta, designed and manufactured in Canada, joins this family of internal support devices with the unique selling point that it is fully reuseable with the manufacturers suggesting replacement after one year.

So if you have had good success with one of the devices above this would be a natural progression to a potentially more environmentally friendly and overall less expensive option.

A clinical trial of 32 women found that of those still using it at 2 weeks (21 women out of the original 32), 76% of them (16) were still using it at their 12 month visit.   Farrell SA, Baydock S, Amir B, et al.  Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women.  Am J  Obst  Gynaecol 2007:196:474e.1-474.e8

There is a helpful video on their website but I couldn’t embed it here.

Beware misleading marketing

Some of the marketing blurbs list “strengthen your pelvic floor” as a benefit of using their device.  This is only true in the loosest meaning – while they are in place, by artificially re-inforcing the vagina wall  I suppose you could claim that is “strengthening” the pelvic floor action – but they are in no way making any change to the muscle.  Only exercise can change the composition and activity of the muscles or surgery the non-muscular elements.  When you take the device out the structural situation remains the same.   However, these devices definitely offer an alternative to surgery with a similar mechanism of action, mechanical suppport of the urethra to the TVT and colposuspension procedures.

Living life to the full

Therefore I would suggest that these devices are part of your package of things you are doing/using to change the way that bladder leakage limits your lifestyle with your goal to cure your leakage problem rather than simply manage it, if possible.

However, if you are feeling more confident to exercise because you are not worrying about leaking,  then this will be a Good Thing for your overall health, wellbeing and mood.   Do contact your local specialist physiotherapist to help support you with finding the right products, exercises and sports for your needs.

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