Forgotten Incontinence “Technology”

In an age where it’s all about the latest technology and the fastest or quickest way to get something done, we tend to forget about medical devices that have worked well for ages. They often have been abandoned because they were considered outdated or because clinicians weren’t sharing them with the next generation. Older medical devices can get relegated to back shelves and pushed aside when something newer and shinier comes along or when the media noise is about what’s new and promoted by industry. 

As health care professionals (HCPs) and patient advocates, we often may find ourselves seeking only the latest incontinence devices and drugs — that is, the ones making the biggest headline splash, producing the loudest noise on social media, and flashing incessantly across the TV screen — because these are the only ones that are part of the racket. It’s easy to forget older, tried-and-true devices (some with recent upgrades) may perfectly suit our patients’ needs and could improve quality of life when properly used under the guidance of an HCP. 

Penile compression devices (ie, clamps) were first described in the 1600s, about the same time a male glass urinal also was described in German medical texts. Penile compression devices prevent male urine leakage by placing enough pressure on the male urethra to prevent urine from leaking out. Most often they are used after a prostatectomy.

Today, many slightly different shapes and styles of clamps are available, including oval, rectangular, and inflatable or static, with some models available in a range of sizes (see Figure 1). A newly designed cuff is adjustable and prevents impedance to penile blood flow. Another cuff has an absorbent pad attached. The basic style has a cushioned inside and a hinged closure. Men may need to try different styles to see which design best suits them, is the easiest to close and open, and is the most comfortable. Some men find they still need a small pad inside their underwear when wearing the clamp, just to catch sneaky leaks. 

Penile compression devices are mostly sold through online retailers or from the manufacturer’s website. These sources should provide the person looking to purchase a device with information on measuring to ensure the correct size is purchased. Nurses providing clamps to patients should provide instructions on proper use/clamping to avoid clinical and legal repercussions of improper use of the device.

Penile compression devices serve a genuine need for men seeking: 

• A comfortable alternative to a pad or diaper-like product;
• A way to prevent leakage for a short and specific amount of time (eg, swimming, going out to a restaurant, attending a special event);
• A management solution for stress urinary incontinence; or
• Overall leakage prevention, which is critical to their lifestyle.

Men who have post-prostatectomy leakage are often particularly well-suited for these devices. However, this product is not suited for the men who:

• Lack good manual dexterity (unless they have a reliable caregiver willing to help);
• Have poor memory or mental function because they could easily forget to remove it after a safe amount of time (unless they have a reliable caregiver willing to help);
• Have skin that may easily become damaged;
• Lack bladder sensation;
• Have retention with overflow incontinence; or
• Have urgency or urgency with incontinence. 

Patients must exercise great care when using this product; they need to completely understand this is not an around-the-clock management device and that it should be removed/unclamped for 4-hour intervals at a minimum. The device should not be worn at night in bed. If used constantly or for long periods of time, the clamp may cause serious complications, such as pain, urethral erosion, obstruction, and edema. Used properly and for short intervals such as a movie, dinner out, or a picnic, this device will help keep the wearer dry and with no fear of an accident.

Vaginal weights/cones also have been used for a long time but are rarely discussed or written about. Such devices are used to help women exercise and strengthen their pelvic floor muscles to reduce urinary leakage from stress incontinence. Vaginal weights/cones usually come in a set of incremental weights. Most of these devices are smooth and made of plastic on the outside with a metal weight housed inside. They have a string attached to the bottom to help the woman remove them after exercising (like a tampon). They are usually shaped like a V but some of can also be shaped like a ball (see Figure 2). 

Women can use these devices in the comfort and privacy of their own home. When using a set of weights/cones, a woman should start with the lightest first, placing the device completely into the vagina (not necessarily to the far end, but above the opening). The weight may feel like it is trying to peek out, or it may fall all the way out, so the first time this is tried, the patient may want to stand over a soft towel.

After the device is in place, the patient should try to contract or squeeze the vaginal muscles around the vaginal weight/cone as she tries to remove it from the vaginal opening. She should use her muscles to hold the device in place for a short time. She also should try to imagine getting the weight/cone to move up the vagina by using her muscles, like swallowing upside down. Some patients use the image of an elevator going up and down to assist with this process. The HCP should teach the patient how to make the device go up and down the elevator. Can she make it go fast and then slow? Each time your female patient exercises at home, she should try to hold it longer, and she should try to move that elevator more times with each set. Once the patient can accomplish this with the lowest weight, she can begin to use the next weight in the set. As the pelvic floor muscles get stronger, she should be able to stay dry longer.

Vaginal weights/cones can be used by women who have stress urinary incontinence or other problems from a weak pelvic floor. They can be purchased from online retailers. 

Therapists and nurses need to help make sure patients are using the correct pelvic floor muscles with these devices. Exercising must be done regularly (ie, several times a day) for any benefit to occur. Like any exercise program, benefits continue with consistent use; muscles will weaken once again if exercising stops.

There are no known adverse side effects with these weights/cones. Some women may have an aversion to placing something into their vaginas, but this can usually be overcome with some encouragement from their HCP.

In a world where everything is going the way of apps and mind-boggling gadgetry, we need to remember some people prefer time-proven devices that are easy to use, do not come with pages of instructions, and do not depend on Wi-Fi. The clinician can demonstrate proper patient use in a hands-on way and immediately answer any questions. When we take the time to know our patients and learn about their lifestyles, we may find their incontinence management does not need to involve expensive or highly technical devices. All that patients may need is a device that works well within its parameters and the patient’s needs and provides some confidence and assistance to those living with urinary incontinence. 

Each generation of HCPs should be reminded of the tried-and-true devices. Although we need to mindful of their limitations and to properly instruct patients in their use, the oldies-but-goodies have a place in our product arsenals to help our patients ... right alongside that new gadget with the coolest app!

Dr. Faller is ET Nurse Clinical Specialist in Private Practice. Ms. LaGro is Vice President of Communications and Education Services at the Simon Foundation for Continence. This column was not subject to the Wound Management & Prevention peer-review process.

Please correspond with the author at: bethlagro@simonfoundation.org.